The Barriers Affecting Women’s Health

When it comes to women’s heart health, many say the issues are systemic.

Medical professionals often miss or dismiss early warning signs because heart attack symptoms typically are presented differently in women compared to men.

While men typically experience classic crushing chest pain, women may experience more subtle symptoms such as fatigue, shortness of breath, or pain in the jaw, neck, or back.

In 2017, Heart Research UK's gender gap report estimated that differences in care for women contributed to over 8,000 avoidable deaths in England and Wales over a decade.

The report also found that women had a 50% higher chance of receiving an incorrect initial diagnosis after a heart attack, leading to delays in their care. Their heart attack symptoms are often misinterpreted as anxiety or stress.

Before menopause, women generally have a lower risk of coronary heart disease. However, after menopause, oestrogen levels decrease in women's bodies.

Oestrogen plays a key role in controlling cholesterol levels, reducing arterial fat build-up, and maintaining healthy blood vessels.

A study in the journal Heart in 2024 showed that women, Black people, and people from low-income households are less likely to be offered heart surgery in England. Moreover, when they do receive heart surgery, their outcomes are not as good as men's.

Dr Sonya Babu-Narayan, British Heart Foundation (BHF) Associate Medical Director said "Women are less likely to have treatments such as stents, heart surgery, medicines such as statins and access to cardiac rehabilitation, which can reduce the risk of a heart attack happening again."

Dr Roy Jogiya, an NHS cardiologist and Chief Medical Adviser at Heart Research UK, said heart failure accounts for "1% of the entire NHS budget, and we know that heart failure with preserved ejection fraction is more prevalent in women."

However, he added: "One of the joys about cardiology is it's constantly evolving. Each day you learn of something new and newer technologies, and there have been some great advances."

But experts say the issues facing women who suffer from heart conditions run deep.

Elinor Flower, a Research Impact and Communications Officer at Heart Research UK and involved in their campaign HER disease said the representation gap in clinical trials further adds to existing issues.

Historically, cardiovascular research has predominantly focused on male subjects, leading to diagnostic criteria and treatment protocols being less efficient in women. This is a legacy that affects modern health healthcare all over the world.

Flower emphasises that while there is more awareness being focused on the gender gap and legislation is being passed so research is more representative of the population affected by the conditions being researched, the gaps remain.

Many women remain unaware that heart disease is their greatest health threat, largely because of the persistent myth that it primarily affects men and the lack of research done around women’s heart health.

Flower states: “This is not one doctor, this is not one hospital. This is not one trust, this is not even one country.

“This is a very long standing cultural exclusion of women from medical research in general, but particularly cardiovascular health.

“It's one of the areas where there's still one of the biggest gender gaps in research.

“We're in a position where because women were so historically excluded from research, the textbooks were written on men, the drugs were tested on men and even the majority of mice used in animal studies are male and that's still the case.”

She adds that while some current research initiatives are encouraging: “There are some really deep wounds that need to heal if we're going to see genuine equity when it comes to medical representation.”

For both Dr Roy and Elinor, education and awareness remain critical challenges in improving women's heart health outcomes.

Flower says: “There is a study out there that has actually shown that when a man and a woman present to a cardiac centre with the same symptoms and the same family history, that the man is more likely to get a referral to cardiology than the woman.

“Yes there is some genuine scientific element to the difference in diagnostics, but there is also a cultural difference when it comes to diagnosing women with heart conditions

“And we know that women's pain is often misrepresented, it's often not listened to. We see that all the time in gynaecological conditions and I think that is something that absolutely holds true across cardiovascular care.”