Why women with heart issues are undertreated and have worse outcomes than men

According to the American Heart Association, heart disease is the leading cause of death for women in the United States. Many of these deaths could have been prevented if women were treated earlier. But due to vague symptoms and women ignoring their discomfort, they often are not diagnosed and treated soon enough.

Many of the symptoms of a heart attack in women are the same as in men:

• Chest pain or discomfort
• Pain in one or both arms, neck, jaw, stomach or back
• Uncomfortable squeezing, pressure or pain in the center of the chest (lasts for a few minutes, goes away and comes back.)

But women are more likely than men to experience other common symptoms in addition to chest pain:

• Shortness of breath
• Nausea
• Vomiting
• Back or jaw pain
• Fatigue

Women who come to the emergency room with subtle symptoms such as nausea and fatigue often are sent home or told they have anxiety rather than being treated for a heart attack, explains Dr. Lauren Barron, assistant professor of surgery in the Division of Cardiothoracic Surgery at Baylor College of Medicine. She says most of the research that has been done on heart attacks – symptoms, treatment and more – has only been studied in men. As a result, protocols for diagnosing and treating heart attacks are tailored for men.

“We as women are a different group of people and, unfortunately, we don’t have enough data to publish specific guidelines to say, ‘When you see this, do this,’” Barron said. She says women who come to the ER with a combination of chest pain and jaw pain, feel a tingly sensation, fatigue or nausea should be assertive and specifically ask to have a heart attack ruled out.

According to the American Heart Association, only 38% of clinical trial participants in 2020 were women. And there are significant biological differences between men and women that the research has not investigated fully yet.

“Is the way we treat heart disease in men the same way we should treat women? We are not sure,” Barron said.

Fortunately, she and other researchers are trying to change the availability of data showing best practices for women. In fact, Barron and her team are gearing up to participate in the first cardiac surgery clinical trial for women called Randomized comparison of the clinical Outcome of single versus Multiple Arterial grafts (ROMA). ROMA, based out of Weill Cornell Medicine, is a multi-institutional and international study aimed at determining what is the best treatment strategy for women who need coronary artery bypass surgery.

This study will look at whether doing multiple arterial grafts for a Coronary Artery Bypass Graft (CABG) is the best approach for women. CABG is a procedure commonly used to treat plaque buildup in the arteries that block blood flow to the heart. Previous research shows multiple arterial grafts lead to better outcomes for men, but the investigators want to know if the same is true for women.

In addition to protocols not being specifically created for women, there are other reasons women with heart disease are undiagnosed or treated late. Women are caregivers and push through discomfort and pain. When women don’t feel well, they don’t stop doing things. They just choose easier tasks to perform. As a result, women are sicker and their heart disease is more severe when they finally seek treatment.

Barron is hopeful that women will step up and be counted so that surgeons like her and her colleagues will know what benefits this group the most. “Women can absolutely advocate for their own cardiac health and shouldn’t hesitate to ask their doctors and providers if they are eligible to participate in studies,” she says. “It is through this type of advocacy and selflessness that the next generations of women will receive the best cardiac care that medicine has to offer.”

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By Tiffany Harston, communications associate in the Michael E. DeBakey Department of Surgery at Baylor College of Medicine