Two winters ago I tromped up and down the streets of my neighbourhood in minus-fifteen weather wearing my red volunteers’ Heart & Stroke Foundation tuque and endured slammed doors, blank stares and mumbled, “No thanks.”
At some houses, four cars were parked in the driveway and still no one answered the door. If I’d known then what I know now, I wouldn’t have taken no for an answer. I would have insisted on a minute to speak my piece—especially if a woman answered the door.
At the end of two weekends, I had dropped off dozens of complimentary brochures and fridge cards detailing the warning signs of heart attack and stroke, and collected one donation: a $20 bill from dear friends down the street who felt sorry for me. I seriously wondered how—if my middle-class neighbourhood was any indicator—Heart & Stroke managed to fund its research and outreach.
Under-diagnosed, Under-treated, Over-dying
Two years ago I knew a little something about the signs and outcomes of heart disease and stroke. But what I’ve only come to know recently, thanks to full-page ads in the Toronto Star sponsored by Heart & Stroke and Shoppers as part of their it’s #TimeToSeeRed campaign, is the heightened risk to women.
“Women are under-researched, under-diagnosed, under-treated and over-dying,” warns the headline. The campaign goes even further, calling women “victims of a gender-biased system that is ill-equipped to diagnose, treat and support.”
There’s a familiar ring to this, of course. I’ve been grumbling for the past few years about certain procedures particular to women that are no longer covered (or covered less frequently) under the Ontario Health Insurance Plan. Pap tests, for one, are now done only every three years.
As well, women no longer get hands-on breast exams as part of their mammograms. The technicians I’ve talked to at several Ontario Breast Screening centres just shake their heads over the cancellation of a procedure once deemed necessary.
But nowhere have we as women been more under-treated than in the area of heart health. Consider these facts and figures:
- Every 20 minutes a woman in Canada dies from heart disease.
- Five times as many women die from heart disease as breast cancer. In fact, it is the leading cause of premature death for women in this country.
- Early heart attack signs were missed in 78% of women.
- Two-thirds of clinical research on heart disease focuses on men.
It’s not that the inequities haven’t been acknowledged in the past. Health Canada apparently put out guidelines 20 years ago that strongly recommended women be included in research and clinical trials. But according to Heart & Stroke’s 2018 Heart Report, “When it comes to heart health, the glass ceiling is as thick as ever.”
It’s even thicker when looking at the health histories of Indigenous women, who experience a death rate from heart disease 53% higher than for non-Indigenous women. Women living in poverty or in remote locations, and ethnically diverse women are also at considerably higher risk.
Our Hearts Are Different
Part of the challenge is that our hearts are different than men’s, which means we experience heart disease and heart attacks differently. According to Dr. Karin Humphries, scientific director of the B.C. Centre for Improved Cardiovascular Health and a consultant for the 2018 Heart Report, these differences are important, “irrefutable and still poorly understood.”
Our hearts are smaller, as are our coronary arteries. We tend to have lower blood pressure and faster resting heart rates. Women’s hearts are affected by hormones, pregnancy and menopause. There are even differences in the way plaque builds up in our blood vessels.
So when that greatest of all muscles is in distress, it also feels different. Unlike the textbook “elephant on my chest” heart attack many men describe, women tend to report nausea, jaw pain, deep fatigue, shortness of breath, dizziness. No wonder so many women get sent home from emergency rooms. No wonder those “non-male” symptoms result in that shocking 78% of missed early signs.
But things could be looking up. There’s the alarmed, imperative tone struck in this year’s Heart Report (“Heart & Stroke doesn’t just envision a better future for women’s hearts—we’re demanding one”) and the can’t-miss newspaper ads. Researchers, too, are finding new ways to encourage and enable women of all ages and backgrounds to take part in clinical trials. Because if they don’t know us, they can’t help us.
That said, there’s also the matter of helping ourselves. For so many women, taking care of others is a huge part of our identity, our self-worth. Surveying 2000 women across Canada in June 2017, Heart & Stroke took stock of women’s lives. “What women told us is that the act of caring is their strength,” explained the agency’s CEO, Yves Savoie. “What we as families, as spouses, as a society, need to do is to help women understand that taking control of their own health is actually part of caring, too.”
If you’re interested in learning about your own heart health risk, Heart & Stroke offers an online risk assessment. It tells me I'll live to 100. (Okay, 91.)