Wednesday's report from the Heart and Stroke Foundation of Canada, via Canadian Press, brought back an old, familiar heartache. It announced that in Canada, women are now more likely to die from heart attacks or strokes than men. We've known for some time that heart attacks in women are more likely to be misdiagnosed, but that gender disparity has always been more understandable given the fact that heart attacks were more likely to assail men than women. Not so anymore -- according to the report, the times have changed, and not in women's favor.
According to the study, in 1973 heart attacks killed 45,000 men in Canada and only 34,000 women, but by 2003 the number of deaths for men had dropped to 37,000 while women's deaths rose to the same number. Since the disparity of women dying from strokes compared with men has gone from 10 percent higher than men three decades ago to a whopping 41 percent higher, now women's risk of dying from a heart attack or stroke is significantly higher than men's.
Why? The study offered a number of theories, including biological differences between men's and women's heart disease as well as poor access to care and the possibility that the medical establishment doesn't recognize women's heart disease as readily. Women's heart attacks don't necessarily manifest with the classic crushing chest pain and numbness down the arm, but can show up with a number of vague symptoms, including sleep disturbance, dizziness, anxiety, fatigue, weakness and shortness of breath. The study also found that women are less likely to be seen by a cardiac specialist and less likely to undergo procedures like angioplasty and bypass surgery than men.
Within the laboratory of my own family I've gotten to watch these statistics play out their fates. When my mother, who already had had a stroke in her 50s and had been diagnosed as having a congenital fibrillation, was rushed to the hospital when experiencing a racing heart and shortness of breath, her doctors ran a battery of tests, told her she wasn't having a heart attack and sent her home still feeling breathless and unwell. The next morning the breathlessness intensified, but by then she didn't want to call 911 -- the doctors had made her feel she was perhaps imagining her symptoms or exaggerating them. A few minutes later, she dropped dead. Her doctor's response? Probably a heart attack. Their explanation for their not keeping her in the hospital? The two episodes of breathlessness and racing heart might have had nothing to do with one another. Hmmm.
In contrast, when, nearly six years later, my father complained of back pain and nausea, his doctor recommended we rush him to the emergency ward, where the E.R. doctors recommended that he go in for emergency angioplasty. Every step along the way, the assumption with my father was that his symptoms were indicative of something real that they could and would do something about. The medical team kept extending his hospital stay just to keep an eye on him -- to make sure everything was all right. He underwent two bouts of angioplasty and survived. What's interesting is that my father had never had any signs of heart trouble -- neither high blood pressure nor high cholesterol -- and his symptoms weren't classic heart attack symptoms. But perhaps the fact that he was a man allowed the doctors to think "heart attack" when they might have thought something else. On the other hand, though my mother already had heart trouble and a history of clotting, her doctors came to very different conclusions.
There has already been a ton written about the disparity between men's and women's heart disease, so you'd think that at least doctors would have gotten caught up on it. But my personal experience doesn't make me terribly optimistic. Last month when I called my doctor's office worried about some weird chest pains and bodily weakness that turned out to be a bizarre one-day flu, my doctor assured me that it wasn't heart related. "It's got to be bone-crushing pain," he told me, as if quoting from a list of typical male symptoms.
Of course, anecdote isn't science -- and I'll never know or fully understand the medical details of my parents' cases. But a recent Jerome Groopman piece in the New Yorker about the often instantaneous (and not necessarily rational) cognitive processes many doctors use in diagnosing their patients makes one realize how even a very slight misunderstanding of women's heart attack symptoms, combined with a microscopic tendency to discount what women self-report, could be amplified into medical malfeasance on a grand social scale.