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Heart disease is a term used to describe a number of diseases which affect the heart and/or the blood vessels in the heart. Heart disease is one of the leading causes of death internationally1 and in Aotearoa New Zealand for both women and men. How men and women experience heart disease differs due to biological and social factors. Despite this, health care practice is largely informed by research which does not adequately consider or analyse gender or sex.
The most common form of heart disease is ischemic heart disease. Ischemic heart disease (also known as coronary artery disease, atherosclerotic heart disease, and coronary heart disease) is a condition in which plaque builds up in the coronary arteries, narrowing and hardening the arteries and limiting blood supply and oxygen to the heart. This can lead to damage of the heart and heart attack.
The latest statistics from the Ministry of Health shows that in 2010, ischemic heart disease was the second leading cause of death for both women and men in Aotearoa New Zealand after cancer.2 Women made up 46.2% of the deaths from ischemic heart disease. Maori women had twice the mortality rate than non-Maori women, and a greater percentage of Maori women’s death occurred in the 45-64 age bracket (25.3%) compared to non-Maori women (3.9%).Women in Aotearoa New Zealand are almost twice as likely to die within a year of their heart attack compared to men (42% of women compared to 24% of men). Women under the age of 50 who have a heart attack are also twice as likely as men to die from it.3
The World Health Organisation defines sex as “the biological and physiological characteristics” while gender is “the socially constructed roles, behaviours, activities, and attributes that a given society considers appropriate for men and women”.4 Sex and gender matter in health because each impacts on health and wellbeing.Gender and sex differences in heart disease are evident in the development of conditions, the symptoms, and responses to treatment. These differences are compelling reasons for greater consideration of sex and gender in medical research and practice.Men and women have some common risk factors for heart disease, however, the significance of these factors can vary between the sexes. For example, smoking as a young adult has a greater impact on women’s likelihood of developing ischemic heart disease than it does for men. Similarly, diabetic women are at a greater risk of developing heart disease than diabetic men. Other risk factors are unique to women. For example, disorders during pregnancy can increase women’s risk of heart disease in the future.5Social factors also contribute to women’s experience of heart disease. Women are more likely than men to live in poverty and are more likely to experience depression and anxiety, all of which are risk factors of heart disease.When heart disease advances to heart attack, women are more likely than men to present with atypical symptoms including pain in the back, neck or jaw, stomach pain, shortness of breath, cold sweats, and fatigue, as well as the classic symptom of chest pain.6
Despite known sex and gender differences in heart health, medical research fails to adequately investigate or analyse the implications of either.This failing is often present at the initial planning stages of research, when exploring the implications for sex should be built into the experiment. At early trial stages, studies often use male animals or fail to report on the sex of animals used.At the human trial phase, women continue to be a minority, averaging approximately one third of participants in European and US studies. Furthermore, these medical trials inadequately analyse gender. Only half of the European cardiovascular disease trials conducted between 2006 and 2010 included a gender analysis, while in the US only a quarter to one third of mixed-sex NIH-sponsored trials reported results according to sex.As a result, medical research and practice is skewed to the male experience, leaving women at risk for misdiagnosis, sickness and even death.
Women can take action to reduce the risk of heart disease, including exercising regularly, eating healthily, managing stress, and stopping smoking.For more information and advice, go to visit the Heart Foundation », Go Red for Women », or Women’s Health »