We have asked Dr. Kirsten Healy to discuss the reasons why women remain under diagnosed for heart disease and how we can raise awareness for its better diagnosis, prevention, and treatment. Dr. Healy is both board certified in internal medicine and cardiology and an expert in women’s health and gender disparity. She is the Associate Medical Director of The Foundation for Gender-Specific Medicine, a cardiologist at New York Cardiology Associates, an attending cardiologist at New York-Presbyterian Hospital, Weill Cornell Medical Center and a member of our Medical Advisory Board.

Although heart disease is the number one cause of death for both men and women in the United States, and more men and women die from heart disease than all cancers combined, it remains under diagnosed, especially in women. For the past fifty years, more women than men have died in this country from heart disease. Once a woman is diagnosed with heart disease, she will do worse and be more likely to die from it than a man. Why is this? What is the reason for this large discrepancy?

One of the main reasons is the lack of awareness of heart disease in women and not enough focus on the differences in risk factors, presentation and treatment between the sexes. Most of what we know about heart disease has come from studies done on men and designed by men. For various reasons, women have not been included in these studies. It has only been in the last decade that National Heart Lung and Blood Institute (NHLBI) and the American Heart Association (AHA) campaigns were successful at raising community awareness on gender differences in cardiovascular disease. But there is still a lot to do. Continuing to increase the awareness about women and heart disease will save lives. Women know they are at risk for breast cancer¾but they are much less aware of their risk of heart disease. A woman is 5.5 times more likely to die of heart disease as breast cancer and more women die of heart disease at every age than breast cancer (National Center for Health Statistics, 2003.) Research has also shown that women are less likely to act on concerning signs or symptoms suggestive of heart disease.  In 2012 an AHA survey found that 64% of women in the U.S. who believe they are having a heart attack would call 911. That means that 36% would not call 911. The reason for this discrepancy was unclear but the main reasons given were, “I don’t have time to have a heart attack right now” or “I am too busy.” Another study found that when patients called EMS for a heart problem, EMS arrived at the homes of callers equally, but women were 55% more likely to experience a delay in getting to the hospital.

Another main reason for the delay in treatment and diagnosis of heart disease is likely due to the fact that often women present atypically. It is important to note though that like men, the MOST common heart attack symptom in women is pain, pressure or discomfort in the chest. However unlike men, women are more likely than men to have heart attack symptoms unrelated to chest pain such as neck pain, jaw pain shortness of breath, nausea and vomiting, light headedness and dizziness. These symptoms may be more subtle than the obvious crushing chest pain and may occur when women are resting and even asleep. Because of its frequent atypical presentation in women, it can be difficult to recognize, and women can downplay their symptoms. A woman having a heart attack will wait longer before presenting to the emergency room. She will be less likely to have a diagnostic electrocardiogram upon arrival and she will be much less likely to be diagnosed correctly.  Even if she is diagnosed correctly, she will be less likely to receive all the life-saving treatments we have today. In addition, when she is diagnosed correctly lifesaving therapies for heart disease will be given an average of a 10-minute time delay compared to a man. This is a big difference because morbidity and mortality is directly linked to a delay in initial treatment.