Gender problem in heart research

To the Editor:

Having heard a comment on TV that women suffering heart disease are under – researched and under – cared – for, I phoned the Heart and Stroke Foundation promptly as I found this hard to believe.

I began asking tough questions, and started to see a bright light at the end of a dark tunnel: they mailed me the booklet “Ms Understood.” The front featured three beautiful young women and the caption: “Women’s hearts are victims of a system that is ill-equipped to diagnose, treat and support them.”

This booklet exposes one abomination after another via statements by the CEO of Heart and Stroke, plus several doctors.

CEO Yves Savoie: “Women’s hearts are still misunderstood. We are decades behind in our knowledge of the differences between men’s and women’s hearts” – because for many years research had limited women’s representation as subjects. Every aspect of health care for women was impacted and continues to be today.

The thalidomide tragedy in the early 1960’s promted the prohibition of women from participation as research subjects until 1997, when Health Canada revised the guidelines, setting out conditions and recommendations for safe inclusion of women as research participants.

Thus, 35 years of possible women’s research was thrown to the wind. However, as other health conditions in women become more difficult to interpret, so women’s inclusion in research remains limited. Why did they not launch more sophisticated research and sort out such intricacies?

Early heart attack signs were unrecognized in 78 per cent of affected women. No wonder!

A woman dies of heart disease every 20 minutes in Canada; what else can be expected when women are decades behind as subjects in heart research?

According to the American Journal of Cardiology, “Only 22 per cent of primary care physicians and 42 per cent of cardiologists felt well-prepared to assess heart attacks in women.”

The above physicians indicated a desire for improved education in women’s heart disease (including younger women).

I appreciated Heart and Stroke’s honesty in admitting that they, along with “other organizations called on women to take charge of their hearts… Heart health was a matter of women’s personal responsibility.”

When I began teaching driving for the AMA in the 60’s, evenings, to augment my $212.74 per month teacher’s salary, I needed an annual intensive medical to retain my instructor’s licence. So I coerced Joan into doing the same, this being the best way to discover a debilitating illness early – so we thought.

These medicals continued for over 50 years, and Joan complained for years of a dry cough, later on additional shortness of breath, finally being forced to struggle out of bed and sitting upright in order to breathe. The day following her last medical in Calgary, she saw Dr. Keaveny in Slave Lake; in three days he dad diagnosed congestive heart failure. He immediately prescribed the full gamut of heart medications, and her improvement was radical.

Dr. Keaveny and two colleagues independently found that the probable origin of her CHF was her rheumatic fever at age 12. It had been undiagnosed at that time but the symptoms were all there.

Her mitral valve and left ventricle had been severely damaged, depressing her blood ejection rating to 10 per cent. Referred to the Heart Function Clinic at the Royal Alexandra Hospital, in 2008 she became part of a worldwide research study on the efficacy of a new concept: the combination pacemaker and defibrillator, known as the ICD.

Dr. Sivakumaran headed up this study, originally intended for two years but so intensely important that it unexpectedly became a five – year project, which produce another innovation: the left ventricle a patient can carry in his jacket pocket.

The Mazankowski Heart Institute now has over 200 patients doing this, successfully. When the Mazankowski was opened at the University of Alberta Hospital, her specialist moved her there, and over six years ago she joined a further study.

Since the batteries in an ICD do require replacement, for which they beep to warn the patient at least six weeks ahead, Joan has had two re-implants. Because her natural pacemaker, incapable of operating her heart, began to conflict with the electronic one, an ablation was performed – burning out the natural one with radio waves, and leaving her running entirely on a battery. Her heart’s blood ejection rate has now risen to 45 per cent; a low normal reading would be 50 per cent. The doctor stated that is is now “up to us to move it up to 50 per cent.”

This group of physicians, including Dr. Jones ( her cardiologist) and Dr. O’Keeffe have thrown a medical safety net around her, having monitored her condition for up to 20 years.

Remember, she was supposed to be responsible for her own heart – all her adult life – until rescued by those four doctors.

The Heart and Stroke Foundation is now trying to get more women involved as subjects in heart disease research across the country, but they need more financial donations.

We have to realize what our hearts are up against : picture your arteries, veins and capillaries attached end to end. To untangle the long rope you would have to wrap it around the earth almost four times.

The heart now has to move 2,000 gallons of blood through these vessels every 24 hours. With each inhalation, the oxygen ccoming into your lungs will enter the millions of tiny air sacs (alvioli).

The total area of the inner surface of these air sacs equals about 75 square metres. Then your blood will absorb and carry this oxygen back to your left ventricle, which will pump it to your brain, heart and extremities.

Here is the crux of the gender problem in heart research: when women were questioned about their symptoms of a heart attack, their descriptions were so complex, so sophisticated that it became difficult for the researchers to wrap their brains around what they must feel.

Men, on the other hand; much easier to understand in their descriptions – “I have big pains in my arms and an elephant is sitting on my chest” – were readily admitted as subjects. The belief was that one plan fits all, except in the case of women, whose punishment was to be left decades behind for their perceived incoherence.

Their comments vary from complaints of nausea to jaw pain: in any case these are often viewed as hysteria or hypochondria. Women should be taking responsibility for their own hearts? What a cruel joke!
Bypassed as subjects in heart disease research, yet dying at a rate of one every 20 minutes in Canada, many women are “dying before reaching their expected life span.”

In our professional opinion, leaving so many women in such a vacuum is criminal and should be treated as such.

P.S. Much of the above information was borrowed from “Ms Understood”. Our thanks to the Heart and Stroke Foundation CEO, and several doctors who contributed to this publication.

Don and Joan Calvert
Marten Beach

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