Modern silent causes of death striking women: Heart attack? Debunk misconceptions.
Challenge this narrative.
Image: People Images, 2021
According to the American Heart Association, globally, cardiovascular diseases have been
the leading culprit of mortality and morbidity among women for the last two decades.
(Mozaffarian et al., 2015). This trend is particularly true for women under 55, with emerging
data criticizing the stagnation and worsening risk factors in young women. For instance, the
Australian Institute of Health reported than half a million women live with cardiovascular
diseases.(Health and Welfare, 2019). The staggering statistic highlights the imperative nature
of restructuring our healthcare institute and its building blocks of research, clinical practices,
and public awareness.
Why are sex-based representations significant between men and women in
cardiovascular health?
Firstly, biological differences in the cardiovascular system are due to differences in gene
expression from the sex chromosomes and hormones influences.(Garcia et al., 2016). As a
result, the way heart attacks manifest between men and women are drastically different,
including different entities and symptoms. Various research bodies suggested that while
plaque rupture is common in men, women’s heart attacks are rooted in plaque erosion. On a
pathological level, this is due to an interaction between coronary pathology and women’s
biological sex characteristics. Hence, there is an increased prevalence of plaque erosion in
women. (Farb et al., 1996).
In the case of plaque erosion, over build-up of smooth muscles and inflammatory cells
resulted in a weakened plaque. Subsequently, regardless of imminent cardiovascular distress,
the clot laid a foundation for muscle paralysis. Collaterally, the heart became strained slowly,
yet fatally failed. (Virmani et al., 2006) Biological differences also extend to how women and
men present heart attacks. While heart attacks are traditionally associated with men’s rapid
and aggressive symptoms, women experienced more muted warning signs. The symptom
includes pain in the upper back, jaw, and neck, unusual fatigue, dyspnoea, and indigestion.
Most importantly, shoulder and arm pain are twice as predictive of a heart attack diagnosis as
women are less likely to experience central chest pain. (Rosenfeld et al., 2015)
Implications of social determinants in Response to health care Barriers
The cultural myth of women being “protected against health attacks” encompasses
underrepresentation in research, treatment delays, and misdiagnoses, culminating in woman’s
inferior health outcomes. While our current healthcare system is challenged with these
inequalities, the core issue lies in the lack of public awareness and scientific-based
guidelines. Namely, in 1997, only 30% of American women surveyed were aware that heart
attack was the leading cause of death in women. (Mosca et al., 2010)A factor contributed to
this issue was the underrepresentation of women in clinical trials, averaging to 20%. (Jin et
al., 2020) Furthermore, the median delay time for women was 53.7 hours as opposed to men.
Paradoxically, physicians are less likely to refer women to coronary angiography despite their
compounded risks. (Poon et al., 2012). Lastly, in terms of treatment, candidates eligible for
repercussion therapy were more likely to present with no symptoms, which inhibits them
from life-saving procedures. These reports reflected how the current societal construct and
our healthcare institute had failed women in multiple principles, leading to health burdens
and complications.
Current progress – a step in the right direction
Amidst this dilemma, multiple organizations from government and educational forces had
joined hands, raising awareness of heart attacks in women from 24% in 1997 to 56% in 2012.
(Mosca et al., 2013) Such efforts created rippling effects into the advancement of science,
including greater recognition of non-traditional risk factors ranging from autoimmune
disorders, obstructive sleep apnoea, and pregnancy-associated conditions. Most significantly,
comprehensive preventive healthcare was proven effective in reducing risk factors in women,
promoting better health outcomes and equality for women. (Raeisi-Giglou et al., 2018).
In conclusion, women’s health is an endeavour that requires more care and recognition from
the medical community. Changes can stem from problem identification, enabling better
guidelines to thrive.
FARB, A., BURKE, A. P., TANG, A. L., LIANG, Y., MANNAN, P., SMIALEK, J. & VIRMANI, R. 1996.
Coronary plaque erosion without rupture into a lipid core: A frequent cause of
coronary thrombosis in sudden coronary death. Circulation (New York, N.Y.), 93,
1354-1363.
GARCIA, M., MULVAGH, S. L., BAIREY MERZ, C. N., BURING, J. E. & MANSON, J. E. 2016.
Cardiovascular Disease in Women: Clinical Perspectives. Circulation research, 118,
1273-1293.
HEALTH, A. I. O. & WELFARE 2019. Cardiovascular disease in women. Canberra: AIHW.
JIN, X., CHANAMOULI, C., ALLOCCO, B., GONG, E., LAM, C. S. P. & YAN, L. L. 2020. Women's
Participation in Cardiovascular Clinical Trials From 2010 to 2017. Circulation (New
York, N.Y.), 141, 540-548.
MOSCA, L., HAMMOND, G., MOCHARI-GREENBERGER, H., TOWFIGHI, A. & ALBERT, M. A.
2013. Fifteen-Year Trends in Awareness of Heart Disease in Women Results of a 2012
American Heart Association National Survey. Circulation (New York, N.Y.), 127, 1254-
1263.
MOSCA, L., MOCHARI-GREENBERGER, H., DOLOR, R. J., NEWBY, L. K. & ROBB, K. J. 2010.
Twelve-year follow-up of American women's awareness of cardiovascular disease risk
and barriers to heart health. Circulation Cardiovascular quality and outcomes, 3, 120-
127.
MOZAFFARIAN, D., BENJAMIN, E. J., GO, A. S., ARNETT, D. K., BLAHA, M. J., CUSHMAN, M.,
DE FERRANTI, S., DESPRÉS, J.-P., FULLERTON, H. J., HOWARD, V. J., HUFFMAN, M. D.,
JUDD, S. E., KISSELA, B. M., LACKLAND, D. T., LICHTMAN, J. H., LISABETH, L. D., LIU, S.,
MACKEY, R. H., MATCHAR, D. B., MCGUIRE, D. K., MOHLER, E. R., MOY, C. S.,
MUNTNER, P., MUSSOLINO, M. E., NASIR, K., NEUMAR, R. W., NICHOL, G.,
PALANIAPPAN, L., PANDEY, D. K., REEVES, M. J., RODRIGUEZ, C. J., SORLIE, P. D., STEIN,
J., TOWFIGHI, A., TURAN, T. N., VIRANI, S. S., WILLEY, J. Z., WOO, D., YEH, R. W. &
TURNER, M. B. 2015. Heart Disease and Stroke Statistics—2015 Update: A Report
From the American Heart Association. Circulation (New York, N.Y.), 131, e29-e322.
POON, S. M. D. M., GOODMAN, S. G. M. D. M., YAN, R. T. M. D., BUGIARDINI, R. M. D.,
BIERMAN, A. S. M. D. M., EAGLE, K. A. M. D., JOHNSTON, N. M. D., HUYNH, T. M. D.
M., GRONDIN, F. R. M. D., SCHENCK-GUSTAFSSON, K. M. D. P. & YAN, A. T. M. D. 2012.
Bridging the gender gap: Insights from a contemporary analysis of sex-related
differences in the treatment and outcomes of patients with acute coronary
syndromes. The American heart journal, 163, 66-73.
RAEISI-GIGLOU, P., VOLGMAN, A. S., PATEL, H., CAMPBELL, S., VILLABLANCA, A. & HSICH, E.
2018. Advances in Cardiovascular Health in Women over the Past Decade: Guideline
Recommendations for Practice. Journal of women's health (Larchmont, N.Y. 2002),
27, 128-139.
ROSENFELD, A. G. P. R. N., KNIGHT, E. P. M. S. N. R. N., STEFFEN, A. P., BURKE, L. M. P. H.,
DAYA, M. M. D. M. S. & DEVON, H. A. P. R. N. 2015. Symptom clusters in patients
presenting to the emergency department with possible acute coronary syndrome
differ by sex, age, and discharge diagnosis. Heart & lung, 44, 368-375.
VIRMANI, R., BURKE, A. P., FARB, A. & KOLODGIE, F. D. 2006. Pathology of the Vulnerable
Plaque. Journal of the American College of Cardiology, 47, C13-C18.
