Heart diseases, a stealthy lady-killer

Is there a gender bias when it comes to diagnosis and treatment of heart diseases in women?

Young women, experiencing chest pain or shortness of breath, for instance, are less likely than men to go in for a heart-related intervention, revealed a study at the last World Congress of Cardiology in Australia, throwing light on a problem that resonates in India as well.

The pattern is not too different here, says preventive cardiologist Aashish Contractor, outlining two key reasons.

While symptoms of a heart problem are manifested in a different manner in women, doctors, for some reason, don’t tend to associate them with heart disease. For instance, a lady who is short of breath, while climbing stairs, is less likely to go for an investigation for heart disease, he explains.

Even if she does go for a heart-related stress test, women are known to show false positives, he says, offering a tiny insight into why gender specificities linked to the heart are so crucial.

As for treatment, it involves expensive surgeries. So when it comes to a choice between spending ₹4 lakh for a surgery on an earning male member and treating a heart problem in a woman manifesting a symptom, chances are the man gets treated, he says, holding a mirror to the uncomfortable reality of our society.

Gender bias in diagnosis and treatment of heart ailments becomes important, since it is the leading cause of death in women, but is not as recognised, says Contractor. According to the American Heart Association — heart disease, a leading lady-killer, is “more deadly than all forms of cancer combined”.

The gender bias recorded overseas may well be more in India, says Sudhir Pillai, interventional cardiologist, Mumbai-based Hinduja Hospital.

Women go in for late medical attention since symptoms overlap with peri-menopausal symptoms and the changes recorded by the ECG test are minor or non-specific, he explains.

Besides, men are seen as being more active, he suggests, a possible reason why symptoms draw immediate attention.

Outlining some women-specific peculiarities, he says, their arteries are narrower than men, and the body surface area is less.

Though there are no statistics to entirely support it, a by-pass surgery is seen to be less effective in women than in men.

Also, given the body mass difference, women tend to have less tolerance to certain drugs, he points out.

A good doctor will be cautious while advising a woman with a heart ailment, keeping these nuances in mind and adjusting dosages accordingly, not ignoring symptoms, bleeding, and so on, he explains.

Gender bias in heart ailments has been noted for over a decade, says Srinath Reddy, pointing to the worrisome feature of “observer bias” that tends to overlook the dramatically changing lifestyle of women.

The general understanding is that stroke is common in women, while a coronary heart disease is noted more in men. Women are believed to be largely protected by the estrogen produced by the body, says Reddy, head of the Public Health Foundation of India and former head of cardiology, All India Institute of Medical Sciences.

Observer bias is when patients are assessed for heart diseases as it were years ago, where heart attacks were expected equally in men and women only after they were 60 years old.

But, changing lifestyles has meant that young women are losing their defence against heart ailments due to smoking (tobacco), oral contraceptives and diabetes.

This gets compounded by under-reporting of symptoms and biased assessment, leading to incorrect treatment, he says, urging women to take greater control of their lives by understanding their heart and heath.

Earlier, women worried only about breast cancer, but coronary heart disease is a leading killer, he says, planting a life-changing thought as another Women’s Day dawns this Sunday.