By the middle of the twentieth century, heart disease had emerged as a leading cause of death across the globe, and scientists were scrambling to better understand the condition.
In 1950, a group of physicians formed the International Society of Cardiology (ISC) to jumpstart research on the subject and share findings across borders. Their studies on young soldiers killed in the Korean War, which began the same year as the ISC, shocked the medical establishment by revealing heart disease started far earlier in a person’s lifetime than previously suspected.
While the findings of heart disease in young soldiers were alarming, early research was also starting to reveal potential preventive measures. Shortly after the founding of the ISC, American physician Lawrence Craven published an article showing that men who regularly took acetylsalicylic acid (aspirin) had fewer heart attacks.
While Craven’s work and the Korean War findings were groundbreaking, they both suffered from what was a common shortcoming at the time: Neither study included any women.
Because female subjects were often excluded from high-profile heart research, in the public’s eye the disease became associated with men. And even when early heart disease studies included significant numbers of women, the data often highlighted risk factors traditionally linked to men. The most famous finding of the Framingham Study, a large-scale research project that followed a group of men and women to determine the causes of cardiovascular disease, linked cigarette smoking to heart problems. When this data was made public in 1960, men were almost twice as likely1 to smoke as women, cementing the notion that stereotypically male behavior caused heart disease.
The founding misconception of heart disease
These early studies contributed to the myth that heart disease is more common among men. In fact, women’s rate of heart problems is generally comparable to men, but women are less likely to recognize the danger. While the condition is currently the leading cause of death among women globally, in a recent survey only 13%2 said heart disease was their greatest personal health risk.
This lack of awareness risks compounding the danger – because being able to identify risk factors associated with heart disease and provide effective treatments have proven to be the most effective way of attacking the malady.
Although it remains the leading killer of both men and women, deaths from heart disease have dropped precipitously in many countries in recent decades. Germany has cut its mortality rate from heart disease in half since 19603, while in the United States, deaths caused by heart disease fell by almost 60%4 between 1950and the end of the century. Other countries showed improvements in an even shorter period. Argentina nearly halved its number of heart disease deaths in only 15 years5.
These dramatic improvements can be attributed to a number of factors, including public health campaigns aimed at combatting common risk factors. Researchers have managed to pinpoint several behaviors in addition to smoking that can lead to heart disease, including obesity, physical inactivity, a diet high in saturated fat and alcohol abuse. There has also been a shift from observation to active intervention. Physicians have built on Craven’s initial findings and today doctors prescribe a host of therapies, ranging from drugs to reduce blood pressure and cholesterol levels, to surgical stents that can increase blood flow to the heart.
Unfortunately, research indicates that many women do not consider themselves at high risk for heart disease and are less likely to address these risk factors. This may be why older women have seen a less significant reduction in heart disease rates in recent years than older men.
In addition, there are a host of conditions specific to women that can also increase the chance of developing heart disease:
- Women diagnosed with diabetes and high blood pressure during pregnancy are more likely to suffer from cardiovascular issues.
- Women who go through menopause before age 45 may have as much as a 50%6 greater risk of developing heart problems.
- Endometriosis, a condition where tissue similar to the lining of the uterus is found on other parts of the body, can increase a woman’s risk of developing heart disease by as much as 400%7.
Women can also experience different, more subtle symptoms of heart disease than men. For example, while both men and women can experience crushing chest pain during a heart attack, women are more likely to have symptoms like nausea, shortness of breath, or pain in their neck, back, or jaw.
When such lesser known symptoms are combined with a lack of awareness of the prevalence of heart disease among females, women are less likely to report their heart attack to a doctor in a timely fashion.
Making it personal
The good news is that ongoing surveys indicate that educational campaigns are chipping away at the misconception that heart disease only affects men. In surveys of women conducted between 1997 and 2012, the percentage of respondents who correctly identified heart disease as the number one cause of death among women rose from 30% to 56%8.
However, data show that even women who recognize the seriousness of heart disease have difficulty assessing their personal risk. In one study of a group of women who were aware that heart disease is the leading cause of mortality among females, fewer than half the women with significant risk factors perceived themselves to be in danger of developing cardiovascular problems.
The disconnect is especially problematic in a world where physicians have a wide array of modern therapies to effectively treat heart disease. Science has come a long way since the studies of the mid twentieth century. With women accounting for about half of heart disease deaths, they stand to benefit greatly from modern treatments. But for women to take full advantage of the latest discoveries, we need to overcome the lingering effects of the myth that heart disease is a man’s problem and be more aware of the different symptoms that women can suffer.
- Achievements in Public Health, 1900-1999: Tobacco Use - United States, 1900-1999, U.S. Centers for Disease Control, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4843a2.htm
- Gender matters: Heart disease risk in women, Harvard University Health Publishing, https://www.health.harvard.edu/heart-health/gender-matters-heart-diseas…
- Cardiovascular Disease and Diabetes: Policies for Better Health and Quality of Care, OECD, http://dx.doi.org/10.1787/9789264233010-en
- Decline in Deaths from Heart Disease and Stroke - United States, 1900-1999, U.S. Centers for Disease Control, https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4830a1.htm
- Argentina heart attack death rate nearly halved over 15 years, European Society of Cardiology, https://www.escardio.org/The-ESC/Press-Office/Press-releases/Argentina-…
- Muka, T. et al. Association of Age at Onset of Menopause and Time Since Onset of Menopause With Cardiovascular Outcomes, Intermediate Vascular Traits, and All-Cause Mortality, Journal of the American Medical Association, https://jamanetwork.com/journals/jamacardiology/fullarticle/2551981
- Women or Men — Who Has a Higher Risk of Heart Attack, Cleveland Clinic, https://health.clevelandclinic.org/2017/02/women-men-higher-risk-heart-…
- Mosca, L. et al. Fifteen-Year Trends in Awareness of Heart Disease in Women, American Heart Association, http://circ.ahajournals.org/content/circulationaha/early/2013/02/19/CIR…