An equal opportunity killer

Cardiovascular disease has traditionally been seen as something that afflicts middle-aged or elderly men. Turning 40 and trudging off to the doctor for a checkup so you can rest assured that you won't drop dead during a weekly game of pickup hockey has been almost a rite of passage for middle-aged men.

Back in 1973, heart disease and stroke killed 45,404 men, according to figures from Statistics Canada. Thirty years later, the number of male deaths had fallen by 19 per cent to 37,004.

On the other hand, in 1973, 34,924 women died from heart disease or stroke. By 2003, the number of women who died from heart disease or stroke almost matched the number of male deaths: 36,823.

Men still outnumber women when it comes to dying from heart attacks, but the gap has narrowed dramatically since 1973, when twice as many men died from heart attacks as women. In the next 30 years, male deaths dropped by 49 per cent to 10,643 while female deaths fell by 24 per cent to 8,019.

"It's a real concern that women's heart health has not kept pace with men's," said Dr. Beth Abramson, cardiologist and spokesperson for the Heart and Stroke Foundation.

"It's truly an equal opportunity killer."

"Women are living like men and dying like men. We have seen that rates for dying from heart disease and stroke are higher at every age and stage for a woman than a man."

The numbers all around have been getting far better for men — but women have not been seeing the same improvements.

Abramson says there are several reasons, including:

• Women are less likely than men to be treated by a specialist.
•  Women are less likely to receive treatments such as angioplasty or cardiac bypass surgery.
•  Fewer women than men are referred to cardiologists.

"For years, it was assumed that this occurred because women were older and tended to be sicker when they were hospitalized," Abramson said. 

"But even when you control for age and other health conditions, a woman's risk of dying within the first 30 days is 16 per cent higher than a man's for heart attack and 11 per cent higher for stroke."

Researchers don't know why the risk of death in the first 30 days is higher for women. As a cardiologist in Toronto, Abramson says she often sees female patients in her practice who ignore signs and symptoms of heart disease and stroke – leading to potentially deadly delays in getting treatment.

Abramson adds that a lot of women just aren't aware of the risks they face — and men are even less aware of the risks their spouses may face. A national survey by the Heart and Stroke Foundation found that 53 per cent of men believed that the number of heart and stroke deaths was somewhat or a lot less in women than in men.

"Even younger women need to go in for an exam and talk about issues beyond gynecological care. If we address risk at an annual exam, maybe we can prevent some of this."

The foundation has made several recommendations to try to bridge the gap, including:

•  More research into how heart disease and stroke affect women differently than men.
•  Tailoring health-care services to women's needs.
• People need to be more proactive about their own health, including eating a balanced diet that is lower in saturated and trans fats.
• People need to become more aware of their risk for heart disease and stroke.

'Floppy' versus 'stiff' hearts

Heart failure also looks radically different in women and as a result, it is often under-diagnosed. Heart failure in most men is usually due to systolic dysfunction. The heart is weakened, dilated and cannot adequately pump the blood through the body. It is often described as a "floppy" heart. 

On the other hand, female patients with heart failure are usually older but have diastolic dysfunction: a small and "stiff" heart, rather than a dilated or "floppy" heart.  The heart's ability to relax between beats is impaired. 

The symptoms are often not well recognized and, in the presence of a small heart, physicians often will miss the diagnosis. To diagnose diastolic heart failure early on, a doctor orders an electrocardiogram and a blood test to check levels of a certain markers.

But the different ways in which cardiovascular disease affect men and women may not just be differences in approaches to care. A study out of Boston has found that the fine grit in polluted air boosts the risks of cardiovascular disease in older women much more powerfully than scientists previously thought.

It has long been known that fine grit — also called particulates — in polluted air contributes to lung and heart disease, with women possibly more susceptible than men because of smaller blood vessels and other biological differences. But this study found that problems were several times higher than a previous study by the American Cancer Society.

The tiny bits of grit are too small to see, but collectively they form that haze that settles over large industrial areas.

Meanwhile, a Quebec study has found that while cholesterol-lowering statin drugs reduce the risk of death after a heart attack, the effects seem to be greater for men than women. The researchers suggested the reason may be that statins are processed differently in men and women.

Statins are among the best-selling drugs on the planet.