How Medical Science Fails Women’s Hearts

A couple of months ago, I woke up to a tense voice note from a friend, describing how a distant female relative of hers — who had seemingly been “healthy,” so far — passed away from a heart attack. She had been feeling unusually fatigued and nauseous throughout the day. At one point, her family reached out for medical attention, but were told it’s “nothing serious.” But when her symptoms didn’t subside well into the night, they started to rush her to the hospital again. She didn’t make it, though.

How often do we shrug off symptoms like nausea, shortness of breath, or an odd, dull ache in the back as stress, or maybe, even indigestion? Why does it almost never occur to us that the symptoms might just be our hearts trying to tell us it’s struggling?

Here’s why: for decades, heart disease has been misbranded as a “man’s problem,” leaving millions of women overlooked and underdiagnosed. “Cardiovascular disease in women remains understudied, under-recognized, underdiagnosed, and undertreated,” states a Lancet report that also noted a 3% rise in cardiovascular diseases in women in India since 1990.

“Since 1984, more women than men have died each year from heart disease. Heart disease is the leading cause of death in women over age 65, just as it's the leading killer of men,” notes an article by Harvard Health.

And yet, we refuse to acknowledge the burden of heart disease on women — more so, because research on how heart disease presents and progresses in women remains dangerously misunderstood. The consequences, as in the case of my friend’s relative, can be fatal.

The biggest factor contributing to this is, obviously, sexism. Research shows that women’s pain is dismissed and attributed to psychological causes — not just by male practitioners, but by female doctors, too.

“In 2009, my doctor told me that, like ‘a lot of women,’ I was paying too much attention to my body. Saying there wasn’t an issue, he suggested I just relax and try to ignore the symptoms…Until it happened again. And again. First every month, then every week,” wrote journalist Jennifer Billock. Almost a decade passed before any doctor took her symptoms seriously, diagnosed her heart disease, and operated upon her.

Did you know that according to the Journal of the American Heart Association, women who visited emergency departments complaining of chest pain had to wait 29% longer than men before it occurred to anyone to check if they’re experiencing a heart attack? It gets worse: women are seven times more likely than their male counterparts to not just to be misdiagnosed, but also discharged in the middle of a heart attack.

All this is because “medical concepts of most diseases are based on understandings of male physiology, and women altogether have different symptoms than men when having a heart attack.” And this is sexism. Because this is what led to a medical system designed, historically speaking for men. For much of modern history, men were seen as the “default” humans in medical research — resulting in medical research prioritizing men’s bodies, leaving women’s unique experiences as afterthoughts.

The result? Diagnostic tools and treatments that don’t fully address women’s needs.The ripple effects extend to diagnostic criteria, treatments, and even basic awareness campaigns, which are often geared toward men. Couple this with lingering stereotypes — like women being “overly emotional,” “dramatic,” and “hysterical” — and you’ve got a system that routinely fails half the population.

But women aren’t just “small men.” Our bodies are built differently — especially, hormonally.

Let’s take the example of estrogen, which plays a protective role in women’s heart health by helping keep blood vessels flexible and cholesterol levels balanced, acting as a natural shield against heart disease during a woman’s reproductive years. Enter menopause, and as estrogen levels drop, that protective barrier fades, and women’s risk of heart disease begins to rise — sometimes sharply.

“Women develop heart diseases later than men because of the protection in the reproductive phase of their life,” notes a study highlighting the “the importance of monitoring the health of women in their middle age, a critical time in which early intervention strategies should be implemented to reduce the risk of [cardiovascular disease].”

Then, there are conditions resulting from hormonal imbalances — like PCOS (polycystic ovary syndrome) — which can even double the risk of heart disease.

Not only that, but conditions like preeclampsia or gestational diabetes can also increase the chances of long-term cardiovascular risks — rendering pregnancy as sort of a wild card in the realm of women’s heart health, too.

“[F]emale heart patients have a greater risk of adverse drug reactions compared with male patients, and these reactions are generally more serious.Similarly, it has been suggested that women with heart failure may need lower doses of medications than their male counterparts,” explains Dr. Jeske van Diemen from the Amsterdam University Medical Centre in the Netherlands, adding, “Currently we treat many patients as if they were the same, which of course is not the case. Study populations that better represent the demographics of society should lead to more relevant findings that improve cardiovascular outcomes for everyone.”

The bottom line is that heart disease doesn’t look the same for everyone, and it’s high time our healthcare systems caught up with that reality. By addressing the unique ways it shows up in women — and closing the gaps in research and treatment — we can save lives and ensure that women’s health isn’t just an afterthought.