The common misconception of heart disease as a predominately male condition means that women are not aware of their risk factors

I felt unwell for about four or five months….In the centre of my breast I would get a burning sensation… it would go… across my shoulders and down my arm. I was definitely not putting it down to… having a heart attack… I’ll be honest I never went to the doctor. (Janice, age 65)

For the last 12 months I haven’t really felt the best and not being one for doctors I didn’t bother… I just felt a little bit under the weather … I thought it was my age, I am hitting 40… (Debra, age 40)

My father died at fifty‐four… a massive heart attack. My brother… dropped dead. My other brother… he also died…. my eldest brother had a stroke… So I’m very much aware of heart disease in the family… but, when I got the pain… I still didn’t think it was anything to do with the heart… maybe… gall stones… (Bridget age 57)

These are the voices of women who participated in a study published last year in the Journal of Clinical Nursing which examined Irish women’s understanding of coronary heart disease risk factors.

Risk factors like your age, gender and family history or other health conditions you have can put you at an increased risk of getting heart disease. The common risk factors for heart disease include smoking, high blood pressure, high cholesterol, diabetes, older age, obesity and an inactive lifestyle.

The research found that the common misconception of heart disease as a predominately male condition meant that women are not aware of their risk factors for heart disease and even those who had symptoms of heart attack, delayed seeking help as they did not recognise the early symptoms as being heart related.

The study, which was carried out by Dr Rita Smith, Assistant Professor at the UCD School of Nursing, Midwifery and Health Systems, included 30 women aged between 36 and 81 who had presented to hospital with symptoms of coronary heart disease or unstable angina.

The women’s understanding of their own risk factors for heart disease and how this influenced their decision to seek treatment was recorded between 6 and 8 weeks after they were discharged from a Dublin hospital following an acute cardiac event. Data was collected via face-to-face interviews and patient diaries.

The findings revealed that many women did not think about their own risk factors for heart disease when they experienced the symptoms and even those who did, delayed seeking help because they were not alarmed by the symptoms. The study also revealed that women were not aware that the symptoms they were having were early warning signs for a heart attack and this also resulted in them not seeking help as quickly as they should.

Speaking to the Irish Heart Foundation, Dr Smith said the women in her study were not aware of their own risk for heart disease and the gendered interpretation of heart disease as being a disease of men appeared to be a strong influence in this regard.

“Women did not really understand the significance of cardiovascular risk factors. They did not consider their family history for heart disease. Many of the women were on anti-hypertensive medication and cholesterol lowering medication, but they did not link the fact that they had high blood pressure or high cholesterol with the fact that they might get heart disease.”

“Because of the misunderstanding about risk when they had atypical symptoms they didn’t think about their heart. They thought of menopause, they thought of age, they thought they were tired, they thought they were under stress, they didn’t understand the symptoms.”

Dr Smith said it was important for women to know and understand their own risk factors for coronary heart disease.

While men tend to get the more classic symptom of heart attack like chest pain, the symptom presentation in women can be more vague making it harder to diagnose and can result in heart disease being missed in women. A woman can have nausea, tiredness, shortness of breath, back pain or tightness in the jaw rather than the more familiar crushing pain in the chest that may shoot down one arm.

One of the most important messages is to advise women, who are experiencing these symptoms, not to delay-call 999 for an ambulance and get to the emergency department immediately. If women are concerned about more vague symptoms they should contact their GP.

Research has also highlighted that doctors too have a role in recognising that women may have heart problems. Factors such as smoking being overweight or obese, having high blood pressure, high cholesterol, being inactive or having diabetes and a family history of heart problems all increase the risk of heart attack and stroke.
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Understand the symptoms of heart attack in women:

• Chest discomfort: squeezing, uncomfortable pressure or pain in the centre of the chest, that lasts for more than a few minutes.
• Indigestion or gas-like pain, breaking out in a cold sweat, nausea, vomiting, light-headedness and collapse
• Discomfort and/or pain spreading to other areas of the upper body such as the shoulders, neck, jaw or upper arms
• Shortness of breath, unexplained weakness, particularly in the left arm, or fatigue, anxiety or unusual nervousness.
• Not all these symptoms are always present. If only some are present, don’t wait. If you are concerned about symptoms you have, do contact your GP.
• If you think you are having a heart attack, get help quickly and dial 999.

Dr Rita Smith addressed the annual conference of the Irish Association of Cardiac Rehabilitation last month on ‘Women and Knowledge of Cardiovascular Risk Factors’