Is the way medicine designed making women suffer heart attacks in silence due to missed signs and risks of the condition?

In a CNN report, experts pointed out how an underlying sexism in the field has cost lives, with heart disease research and treatments historically tailored for men when the diagnosis and symptoms can be very different between the genders.

Invisibility In Medical Research

Cardiologist Dr. Nanette Wenger from Emory University, starting her career in the mid-1950s, said women had suffered heart disease in silence over a large part of the last century, partly because they were not paid attention to and their male counterparts developed cardiac problems at a younger age.

“[Men] were at the peak of their careers. They were visible. They were in the workplace,” she told CNN.

The long history of scientific research in men’s heart health, she explained, translated to a precipitous drop in rates of the disease from the 1980s — a benefit that women wouldn’t reap until the 2000s came in.

And it’s not just research in heart disease but also in other health areas that largely neglected women. Wenger said it was mostly “bikini medicine” or studying the breasts and reproductive organs alone, with basic research done on male subjects since it was cheaper.

More recent policies proved more inclusive, where women “of childbearing potential” were no longer excluded from clinical studies, and women’s data are better accommodated in studies.

Silent Suffering?

When it came to heart wellness, there were plenty of signs that medicine was a bit slow to account for gender differences. In one study, almost half of women didn’t show classic warning signs of an attack, as they tended to describe symptoms such as nausea and vomiting, breathing problems, and jaw/arm/back problems rather than chest pain.

There are also risk factors unique to females, including premature birth and autoimmune conditions including lupus.

The tests that physicians use for diagnosing heart disease, after all, may maintain a male bias. Traditional treadmill tests may offer a false estimate of women’s risks, while CT scans and angiograms may miss out on heart attack causes in women since their smaller arteries are prone to conditions not reflecting plaque buildup. A clear scan may not readily mean a clean bill of health — at least for women, experts warned.

While crucial, these tests should be chosen and interpreted properly by clinicians, urged cardiologist Dr. Nieca Goldberg. For instance, heart attacks typically stem from a blocked artery. In contrast, women tend to have conditions affecting artery walls but not necessarily blocking them, and they can be fatal as well.

Spontaneous coronary artery dissection, for one, is a rare condition where there’s no plaque blocking the artery, but the artery’s inner wall could get suddenly torn, and blood flow to the heart could be impeded.

Better Days

For doctors, it’s a work in progress. Awareness of heart disease as top killer among women was close to double 13 years after the American Heart Association launched its female-targeted campaign in 1997, and fewer women died of heart disease than men in 2013, or for the first time in almost three decades.

In a recent survey, it appeared that few Americans know their status when it comes to basic cardiovascular risk factors, such as cholesterol levels and blood pressure.

Just four out of 10 surveyed knew a healthy blood pressure level was less than 120/80, and a mere 34 percent knew that upper body fat, particularly in the stomach, is most dangerous for one’s heart.