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Heart to heart: Experts call for an end to gender bias in cardiovascular disease

Despite the fact that half of the 17.3 million deaths from cardiovascular disease (CVD) each year happen in females[i], women are still discriminated against when it comes to the management and treatment of this disease. Women are more likely than men to be under-diagnosed and under-treated, mostly because the presentation, progression and outcomes of the disease are different and less understood in women than in men.  Although there has been progress in raising awareness about CVD in women and studying the specifics of the disease, as well as in adapting CVD treatment and care for women, the gap is still too wide.  A group of leading experts at the World Heart Federation’s World Congress of Cardiology (WCC) is calling for further research, better information for healthcare professionals and women and tailor-made treatments to bridge this gap once and for all.

To celebrate “Wear Red Day” for women at WCC, new research is presented on women’s heart health, alongside examples of work being undertaken in several countries to improve the recognition, prevention and treatment of CVD and practical ways to provide better, targeted care for women.

Professor Linda Worrall-Carter, Director ofSt Vincent’s Centre for Nursing Research (SVCNR) & The Cardiovascular Research Centre (CvRC) will be presenting a new study that further reinforces the need for research and better information for women:  in a sample of 2000 Australian women, Professor Worrall-Carter and colleagues found that young women aged 35-59 years experiencing acute coronary syndromes were less likely than men to undergo coronary interventions. Future research investigating symptom presentation of younger women as well as exploring perceptions of health care workers is needed, as it could explain the reasons of this disparity, says Professor Worrall-Carter, “We need to ensure that all health professionals understand gender differences when it comes to cardiovascular disease.  Awareness regarding atypical symptom presentations of women and understanding healthcare workers perceptions are key to ensure women are getting the most appropriate and timely treatment, no matter their age or background.”

Women themselves also need to be better informed:  CVD is the number one killer of women, but the risk of dying or becoming seriously harmed due to heart disease and stroke is still largely underestimated by the majority of women, who do not perceive CVD as one of their major health concerns.

 The future of the fight against heart disease in Australia

In 2007, the National Heart Foundation of Australia saw and acknowledged the problem of under-recognition, under research and under treatment of heart disease amongst women and decided that it was time to take action.  By spending the last seven years collating data on heart disease in women and developing an awareness campaign, the Heart Foundation have been able to take a number of positive actions with a wide range of stakeholders.

These efforts have been met with great success, as heart disease amongst women in Australia has become better recognised and awareness of this as a killer of women has increased in the population: 40% of women are aware that CVD is their number one killer compared to 20% in 2009.  However the work cannot stop here, said Julie Anne Mitchell, Director of Cardiovascular Health Programs at the HFA: “Over the next five years, the National Heart Foundation of Australia plan to switch their focus from awareness raising to more direct support of women diagnosed with heart disease. This will include a heightened focused on women’s clinical risk factors of heart disease; the atypical symptoms often associated with heart attack; the importance of cardiac rehabilitation and the necessity of sex specific data collection to enable better gender analysis of service provision and use. We plan to build on the work we started back in 2007 and this work will hopefully contribute to a brighter outlook for all women in Australia.”

At the forefront of clinical care: learnings from the US

Across the Pacific, in Chicago and Los Angeles, in-clinic research has looked at the way women seek CVD treatment and how collaborations with colleagues treating other female-specific disease can improve care of CVD for women.

Heart damage related to chemotherapy and premature heart disease is a problem for breast cancer survivors.  Researchers at the Barbra Streisand Women’s Heart Center (BSWHC) at the Cedars-Sinai Heart Institute are calling for the introduction of cardio-oncology clinics, to support cancer survivors in implementing lifestyle changes and preventive measures for heart disease.  The research team has established a multidisciplinary program including cardiologists, breast cancer surgeons, medical and radiation oncologists, as well as colleagues from cardiac imaging and rehabilitation medicine.  Dr Puja K. Mehta explains:  “Out of nearly 900 women we saw at the BSWHC over a seven month period, a significant number of cancer survivors also had cardiac problems such as hypertension, high cholesterol, diabetes or coronary artery disease.  Programs and strategies to identify cardiac risk factors in cancer survivors are needed and represent an excellent preventive opportunity.”

Furthermore, in Chicago, a team of physicians at Rush University Medical Center found that there are important differences between women who seek CVD care at heart centres for women or at general cardiology offices.  Dr Annabelle Volgman of Rush University talks about this research of 365 women and their care preferences:  “Our most interesting finding was that the majority of women didn’t have a strong preference to see a female doctor, however, it was really important to them that the doctor they saw specialized in heart disease in women.  Our research is a starting point in looking at women’s preferences and we need to do more in this area to confirm these findings and put them into practice.”

Go Red for Women

Together with its members across the world, the World Heart Federation runs the annual Go Red for Women campaign to improve women’s knowledge of heart disease and stroke so that they can take action and achieve longer, better heart-healthy lives. On Tuesday 6 May, the World Congress of Cardiology will celebrate Wear Red day and everyone is encouraged to wear something red to raise awareness of CVD in women.  Go Red for Women was created by the American Heart Association to improve women’s knowledge of heart disease and is run globally by over 50 member organizations of the World Heart Federation.

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