Guardian: Cardiologists on 20 simple, successful steps to a healthy heart

[aname1234]

https://www.theguardian.com/lifeandstyle/2023/nov/14/the-experts-cardiologists-on-20-simple-successful-steps-to-a-healthy-heart

And NO mention of the large differences between women's and men's heart attack symptoms.... how very (un)useful...

Arseholes.

The people whom medical training and research ignores - usually women and people of colour - lose lives to this negligence.

But best not point it out eh, incase you upset one of the guys*.

*Women have been informed "guys" is gender neutral term since forever.

Ah, I stand to be corrected!
https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/august/no-difference-in-key-heart-attack-symptoms-between-men-and-women

Anyone else know more about this? However, it still would have been good for the article to mention something about it.

Am I misreading it or the article refers to 40+ being 'older people'?

I'm an A&E doctor and urgent care GP, so I deal with a lot of chest pain.

My experience is that both men and women experience lots of 'atypical' symptoms of a heart attack - which is backed up by this research (41% of men and 23% of women did). However, I have a strong suspicion that women's atypical symptoms are less likely to be taken seriously, and less likely to be suspected of being cardiac.

So, it's not that women necessarily have different symptoms when having a heart attack, it's that their symptoms are less likely to be suspected of having a cardiac cause. This research would not have shown up that difference because everyone studied had already been identified as possibly having a heart attack - the threshold for suspecting a heart attack had already been reached.

What we need is a large study of everyone presenting at A&E with symptoms that could be cardiac but that often have other causes e.g. back pain, indigestion. Then we need to look at what percentage of men vs women with identical symptoms get tested for a heart attack, and what percentage of them were actually having one. I bet you a lot fewer women get tested. But it's really hard and expensive to do this type of broad-based, prospective analysis: you need to follow up 10s of thousands of patients to get reliable data, so don't hold your breath.

Thank you @MissLucyEyelesbarrow, I was about to say exctly this so you saved me a lot of typing.

I'm supposed to be prepping my appraisal, so the temptation to do anything else was strong 😀

However, I have a strong suspicion that women's atypical symptoms are less likely to be taken seriously, and less likely to be suspected of being cardiac.

Yes exactly, they can often get put down to menopausal symptoms, digestive issues etc. AFAIK the type of heart attacks more common in women (NSTEMI) are often not even diagnosed as a heart attack in hospital after they happen when patients are admitted to general medical wards and care of elderly wards, unlike the more obvious ones which tend to happen in men at a younger age (STEMI) who need to be blue lighted into A&E and have emergency angioplasty.

"We identified 305,014 admissions with NSTEMI in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including female sex (n = 110,209). Females presented significantly older (77y vs. 69y, P<0.001), were more likely to be Caucasian (93% vs. 91%, P<0.001) and less likely to be current smokers (18% vs. 24%, P<0.001). Females were less frequently treated with GDMT after NSTEMI, less frequently managed with an invasive coronary angiogram (ICA) (58% vs. 75%, P<0.001) during index admission and less frequently underwent PCI (35% vs. 49%, P<0.001) or CABG surgery (5% vs. 9%, P<0.001) compared to males. Structural process of care differed between the sexes, with a lower proportion of females being treated on a dedicated cardiology ward (48% vs. 56%, P<0.001) or admitted under a attending cardiologist (44% vs. 52%, P<0.001)."

Study published a couple of days ago academic.oup.com/eurheartj/article/44/Supplement_2/ehad655.3027/7391380

My grandmother has had some sort of fairly minor infarction and no one ever knew at the time. She's still alive, with dementia, at 91, it only showed up when she had a routine ECG at the time of her dementia diagnosis. This was over three years ago now. It's not clear when it was, it could have been years ago, or whether she was ever on medication for the symptoms that we weren't aware of. She isn't a fan of visiting the doctor!

I think, in general womens experience in most medical issues are downplayed by doctors and are more likely to have less tests and be over prescribed anti depressants and contraceptives as a cure without finding the underlying problem.

Thanks all for your posts. It's really useful to know the difference between what symptoms to look out for vs not being taken seriously if you do have symptoms. Could part of it be that women's biology is just more complicated rather than outright sexism? I'm being hopeful here..

It's not just misogyny. In the past, men were at considerably higher risk of death from cardiovascular disease (mainly due to higher rates of smoking), so it was reasonable to have a lower threshold for suspecting heart disease in men.

However, misogyny definitely plays a big part. It's usually unconscious bias, not conscious. Most A&E staff will tell you that women are generally more stoical than men, so it's not that we all dismiss women as hysterical or attention-seeking. But misogyny is deeply ingrained in medicine: from Day 1 of Med School, the male body is presented as the norm. Women are a footnote.