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In a concerning statement, the British Cardiovascular Society has highlighted an ongoing issue in the healthcare system: women in the UK remain underdiagnosed and under-treated for cardiovascular diseases. This disparity, rooted in the long-standing perception of heart disease as a “man’s condition,” is placing many women at risk. Understanding the biological differences between men and women, and addressing the unique symptoms women experience, is critical to closing this gap and improving health outcomes.
Biological Differences and Their Impact on Heart Disease
Men and women differ significantly in the anatomy and physiology of their hearts, which contributes to the varying ways heart disease manifests. Research shows that males tend to have larger hearts, with thicker musculature and larger chambers compared to females. Women’s hearts pump faster to compensate for their smaller size, but men’s hearts eject more blood with each beat. These anatomical differences extend to the blood vessels as well, with women having smaller and narrower arteries.
These distinctions play a significant role in how heart disease develops and progresses in women versus men. While heart disease remains the leading cause of death for both genders, many diagnostic tools and treatment protocols have historically been designed with men in mind. This has led to women being both underdiagnosed and undertreated when they present with cardiovascular symptoms.
Atypical Symptoms and Missed Diagnoses
One of the major issues in diagnosing heart disease in women is the difference in symptoms they experience. Traditionally, doctors have been taught to associate chest pain with heart attacks—a symptom commonly reported by men. However, women often present with atypical symptoms, such as nausea, vomiting, dizziness, indigestion, upper back or belly pain, and unexplained sweating. These symptoms, while critical indicators of a potential heart attack, are often misattributed to other conditions, leading to delayed or missed diagnoses.
A 2023 review found that many women who experienced a heart attack were misdiagnosed because their symptoms did not align with the “typical” chest pain commonly associated with heart attacks in men. This oversight can be fatal, as timely treatment is essential in improving survival rates and preventing further heart damage.
The Limits of Current Diagnostic Tests for Women
Even the diagnostic tests used to identify heart attacks are less effective for women. The cardiac troponin test, which measures the presence of a protein released when heart muscle is damaged, often yields lower levels in women, even when they are experiencing a heart attack. This means that heart attacks in women can go undetected if the test results are not interpreted with gender differences in mind.
Additionally, cardiac catheterization, a procedure used to detect blockages in large arteries, is another standard diagnostic tool that may fail women. Since women’s blood vessels tend to be smaller, and they are more likely to experience blockages in smaller arteries, traditional catheterization may not always detect the full extent of their heart disease. Shockingly, studies show that up to 50% of women who present with heart disease symptoms do not show significant blockages after this procedure. As a result, women are less likely than men to be referred for cardiac catheterization or recommended for necessary interventions like revascularization or cardiac rehabilitation.
Changing the Paradigm: Steps Toward Better Care for Women
Although the challenges in diagnosing and treating heart disease in women are significant, there has been some progress. Doctors and nurses are beginning to tailor their approaches to account for the differences in men’s and women’s cardiovascular systems. This includes making subtle adjustments in medical procedures, such as pacemaker calibrations and angioplasty techniques, as well as using more advanced imaging technologies, like intravascular ultrasound, to detect heart disease in women more effectively.
Research efforts are also underway to add sex-specific indicators to existing risk assessment tools for cardiovascular diseases. Numerous clinical trials are focusing on how to improve diagnostic accuracy and treatment efficacy for women, an essential step in bridging the care gap.
Conclusion
While these efforts are promising, far more needs to be done to address the ongoing disparities in heart disease diagnosis and treatment between men and women. Health professionals must continue to recognize the distinct ways in which cardiovascular disease presents in women and adapt their methods accordingly. Only then can we hope to reduce the number of women who are underdiagnosed and under-treated, and ultimately save lives.
