Women not getting equal medical advice when it comes to heart health, study finds

By Dr. Sristi Sharma

Heart disease is the leading cause of death in the United States for both men and women, but women may not be receiving the same treatment, according to a new study.

Though guidelines for heart disease prevention are gender neutral, researchers report that, in practice, doctors advise less aggressive strategies for women.

Researchers from Massachusetts General Hospital examined the advice doctors gave to patients at high risk for heart disease to help prevent their first cardiac event and found that women were advised more often to make lifestyle changes alone.

"Our study found that women are advised to lose weight, exercise and improve their diet to avoid cardiovascular disease, but men are prescribed lipid-lowering medication," Dr. Prima Wulandari, a cardiology clinical researcher at Massachusetts General Hospital in Boston, said in the study findings. "This is despite the fact that guideline recommendations to prevent heart disease are the same for men and women."

The researchers examined the advice that nearly 3,000 high-risk men and women received for prevention of heart disease, based on participants in the U.S. National Health and Nutrition Examination Study from 2017 to 2020.

They found that though both men and women were eligible, men were 20% more likely to be prescribed statins. Women, on the other hand, were almost 40% more likely to receive recommendations for behavioral modifications, like losing weight, exercising more and stopping smoking.

The study was presented Dec. 3 at a medical conference in Singapore.

Close to 700,000 people die of heart disease in the U.S. every year making it the most common cause of death, according to the Centers for Disease Control and Prevention.

Among women, heart disease causes 1 in 5 deaths, and around 1 in 16 women over 20 years of age have coronary heart disease, the most common type of heart disease, according to the CDC.

Coronary heart disease can present with chest pain, nausea, and breathlessness, among other symptoms. However, typical symptoms are mostly seen in men.

Women tend to experience less chest pain than men. Instead, they experience more pain in the middle or upper back, neck or jaw, more dizziness, extreme tiredness, pressure in chest and stomach pain -- all symptoms that can easily lead to misdiagnosis.

Multiple studies have shown that in health care overall, inherent biases among doctors lead to women not being diagnosed or having a delay in diagnosis.

When it comes to why the prevention of heart disease in women is sub-optimal, according to the study, the reasons vary.

One reason, according to Wulandari, is that heart disease may still be seen as something that predominantly impacts men, despite the statistics showing women are also affected.

The rate of coronary heart disease is higher in men until 75 years of age, and women present with more atypical symptoms which could lead to misdiagnosis of their disease.

"A potential root of the discrepancy in advice is the misconception that women have a lower risk of cardiovascular disease than men," said Wulandari. "Our findings highlight the need for greater awareness among health professionals to ensure that both women and men receive the most up-to-date information on how to maintain heart health."

Another potential reason for the treatment bias is that there is an underrepresentation of women in research studies that can lead to practitioners being cautious of generalization of the heart disease management to both genders.

In addition, women themselves may underestimate their own risk of heart disease, and for other chronic health care conditions, it has been consistently shown that women prefer lifestyle intervention over medications.

According to ABC News chief medical correspondent Dr. Jennifer Ashton, in addition to a greater awareness among health care professionals, there are prevention strategies of which patients themselves should be aware.

Around 80% of heart disease can be prevented, Ashton said Tuesday on "Good Morning America," citing American Heart Association data.

Some health changes that can help prevent heart disease include weight management, exercise, eating more fiber and less saturated fat, consuming less alcohol, monitoring blood glucose and not smoking cigarettes.

Ashton, a board-certified OB-GYN, said it is also important to take prescribed medications if indicated.

"If indicated, blood pressure medication, cholesterol-lowering medication for both men and women have been shown to save lives," she said.

Dr. Sristi Sharma is a preventive medicine physician and is a member of the ABC News Medical Unit.