Heart disease is the leading cause of death for women in the United States. According to the Centers for Disease Control and Prevention, heart disease killed 314,186 women in 2021. This means that approximately one out of every five female deaths was due to heart disease, with the worst mortality burden on African American women.
It is abundantly clear that we are not where we need to be in terms of preventing and treating heart disease in women and raising awareness about how heart disease impacts women in both the public and medical communities.
Again, women can’t wait. And neither can our approach to better address heart disease in women.
Because of the female lives heart disease claims, we all have our personal, and oftentimes tragic, stories of a loved one. My story inspires me and will be with me forever. As a physician, my mother was diagnosed with heart disease on the heels of completing my heart failure fellowship. How could I have missed the signs that she was suffering? This is what I trained to do. The signs were there but, unfortunately, were not recognized. This experience shook me to my core. It also demonstrated to me the urgent need for more education in both the medical community and among the general public about women’s heart disease risk.
Highlighted by the American Heart Association in 2016, common symptoms of heart attacks in women, including fatigue, shortness of breath, indigestion, vomiting, and nausea, are too often dismissed by both patients and medical professionals. A study published in the Journal of the American Heart Association in May 2022 showed that women experiencing chest pain waited longer than men to be seen by physicians in the emergency department and were less likely to be admitted to the hospital on account of their chest pain. And a study published in the Journal of Women’s Health in 2009 showed that women experiencing heart disease symptoms (chest pain) were twice as likely to be diagnosed with a mental illness compared to men who reported the same symptoms. This is unacceptable, and we need to do more and improve.
How can we make progress?
Prioritize education and outreach focused on women’s heart health for medical students, physicians in training, and practicing physicians. Research published in Women and Cardiovascular Health in 2022 highlights a lack of sex-specific training for cardiology fellowship programs in the U.S. Formal programs dedicated to women’s cardiovascular health are rare and elective. Let’s make those mandatory.
Focus on heart health in more health care settings. While there are many great heart care centers throughout the U.S., we are missing opportunities to prevent heart disease. Primary care and emergency physicians, among others, must play a significant role in this effort. We can arm them with the training and tools to better identify risks and help prevent heart disease.
Educate women about their heart disease risks more often and more consistently during medical visits. A survey from the American Heart Association shows that while most women are aware that heart disease is the leading cause of death in women, only 13 percent believe it is their greatest health risk. This must change. Too much education is not possible. We know that annual primary care visits are not long enough to address each and every health issue, but given the overwhelming evidence on the risk of heart disease in women, heart health must be a priority. The American Heart Association has many valuable resources available for free that can be shared with patients so that they leave the appointment armed with information to know their risk and recognize if they are in need of medical attention.
Invest in clinical trials focused on women and heart disease. There continues to be profound underrepresentation of women in cardiovascular disease clinical trials, which a 2020 study published in Circulation demonstrates. This could be causing patient harm as the data derived from these studies, which we use to inform treatment decisions for women, is based on studies where a majority of the participants were male. At the American College of Cardiology’s 71st Annual Scientific Session, a study found that there are too few women in cardiovascular clinical trial leadership but that female-led clinical trials increase female trial participants. Let’s use this data to our advantage and improve the engagement of female physicians in clinical trial leadership to increase female participant enrollment.
As we continue our work to better understand the differences in how heart disease presents and impacts men and women, it’s critical to share this knowledge. We know a lot now, but we’re still not sharing that knowledge broadly and comprehensively. While there has been progress made in decreasing mortality related to heart disease in both men and women, one important fact remains – heart disease can be prevented.
I want change now. Women can’t wait. My mother should not have needed to wait. We must act collectively and aggressively now to help save lives.
Roberta (Bobbi) Bogaev Chapman is a cardiologist and vice president for heart failure, Abiomed, Inc., Danvers, MA. She can be reached on Facebook, LinkedIn, and Twitter @HeartRecovery and @abiomed. She leads the Women’s Heart Initiative and works collaboratively on all Abiomed-sponsored clinical trials, education, patient advocacy, and developing best practices for patients with heart failure.