The American Heart Association has released guidelines for stroke prevention in women. They are designed to help healthcare providers focus on gender specific conditions that may increase the risk. While it has long been known that stroke and heart disease manifest themselves differently in men and women, both by in the symptoms presented and how they progress, this is the first time the AHA has focused specifically on the risk factors for women.
The focus on gender differences when it comes to medical conditions is revolutionary because, historically, this hasn’t occurred.
In the early days of HIV and AIDS, women were being diagnosed later and dying sooner because the data about the disease was based on the gay men who it was believed the disease only affected. When men came in manifesting certain symptoms, the doctor would be prompted to get more detail on their history and more quickly identify the possibility of infection. Women, who were usually contracting the disease from their partner or a blood transfusion, were showing symptoms that were often misdiagnosed as something less severe. It wouldn’t be until the disease had progressed that the cause would be identified.
Gender difference is often ignored when it comes to common cancers. More people die from lung cancer than any other cancer worldwide. Women are often diagnosed later than men, delaying the treatment needed to increase survival rate. In 2001, lung cancer deaths were higher for women than for men, fueled by the increase in smoking by women in developing countries. At one point, more women were dying from lung cancer than breast cancer.
While there are obviously gender specific diseases, such as cancers that affect reproductive organs, the bias begins as early as the research stage.
In the laboratory, scientists use male animals as test subjects more than female animals at the rate of five times to one. In research studies and clinical trials for drugs, fewer than 25 percent of the participants are women. The largest studies with women are female only trials that focus on things like breast cancer or issues specific to female reproduction. This can cause skewed results for things like pain studies, where hormonal and genetic differences can affect how men and women experience pain. This can affect dosage recommendations in drugs, or therapy recommendations for treatment.
The bias continues into the doctor’s office.
A study published this week in the Canadian Medical Association Journal showed that men were more quickly diagnosed as having a heart attack than women. This resulted in a delay for women in getting various treatments, such as an electrocardiogram (ECG) or receiving medication to remove blockage. The delay was attributed to how patients presented themselves. Women generally presented atypical symptoms, such as lack of chest pain, typical of “silent” heart attacks, whereas men more often claimed actual chest pain. It also mattered how the patients described their pain. Men were more likely describe it as chest pain, whereas women would explain a general feeling of “uneasiness.” While a heightened state of anxiety is common in such a situation, when presented by women it would be dismissed and more likely delay care.
The new American Heart Association guidelines acknowledge that certain stroke risks are greater in women. The risks naturally increase with age for everyone and current guidelines for stroke prevention focus on controlling blood pressure, quitting smoking and increasing exercise and healthy eating habits. However, older women (over 45) on birth control pills have an increased risk of stroke if they have a history of high blood pressure. The recommendation is to be tested prior to beginning oral contraceptives.
Female specific conditions such as pregnancy, menopause and certain migraines increase the risk of stroke, especially when coupled with high blood pressure or, in the case of menopause, hormone therapy. Migraines are most commonly experienced by women, however only those that present with dizziness or altered senses such as tingling, ringing ears or sensitivity to light – known as aura migraines – are at a higher risk. It is recommended that women over 75 should also be checked for an irregular heartbeat as this has also proven to be a risk factor.
Hopefully these guidelines will improve care for women and decrease the inherent gender bias where it is most helpful – with healthcare providers.