Barbra Streisand and Dr. C. Noel Bairey Merz
The last thing we need during the holidays – especially amid a global pandemic – is another reason to worry, but women, in particular, should be concerned about their heart health.
A decade ago, we joined forces to combat gender inequity in cardiovascular research, treatment and prevention. We knew heart disease was seen as a “men’s disease” despite being the No. 1 killer of women in the United States, that women were excluded from research studies, and that even many doctors didn’t know that women’s and men’s hearts and symptoms are not the same.
But we never imagined a pandemic would impede our progress. That’s what is happening today.
Researchers are predicting a “tsunami” of heart disease and other chronic conditions, a confluence of the COVID-19 crisis, during which deaths from heart disease accelerated, and Holiday heart syndrome, the spike in alcohol – and stress-related cardiac disease.
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Yet, among the repercussions the pandemic will have on the long-term health of American women, we’ve heard little about its impact on our hearts – a reflection of inequity and a pattern of neglect that we’ve been fighting in our health systems, and beyond, for generations.
A disproportionate impact
What we need now is a concentrated, bolstered effort to address the gender and racial inequities in the quality of heart care. And we need much more research on women and heart disease – what makes it different, how best to prevent and treat it. Cardiovascular disease kills about 10 times more women a year than breast cancer. For example in 2018, more than 420,000 women died of cardiovascular disease whereas 42,465 died of breast cancer the same year.
Yet few women know the basics of how to protect themselves.
We know that the coronavirus directly impacts the cardiovascular systems of the infected, something we’re learning more about every day. This cresting wave of cardiovascular illness likely will fall disproportionately on women, especially women of color and low-income women, who are more at risk for cardiovascular disease.
Making matters worse is the fact that compared with men, heart disease among women remains under-recognized, understudied and underrated and women are under-represented in clinical trials.
This must change.
Broken heart syndrome
We’ve long known that stress is a key culprit of heart disease, and a study published in October, and co-authored by Dr. Bairey Merz, builds on this and should serve as a fair warning. It found that from 2006 to 2017, women older than 50 were diagnosed with Takotsubo Syndrome, or “broken heart syndrome” – a heart attack-like event resulting from stress – up to nine times more than men of any age group.
Future research most likely will show a substantial spike because of COVID-19, continuing a troubling trend: The number of women who die of heart disease has risen each year over the past decade, particularly among younger women of color.
This is in part because women are less likely than men to get the treatment they need when hospitalized and more likely to do poorly after a heart attack.
Yet only 1 in 5 American women understands that heart disease is the leading cause of death.
Fewer than half of primary care physicians and cardiologists feel well-prepared to assess cardiovascular disease in women.
That this all is happening in 2021 is unconscionable.
Knowing the risk
To be sure, we need the research and investments to bring about systemic changes. However, we also know enough to put a simple solution in place now: Tell women they’re at risk and tell them how to save their hearts.
That starts with educating women about the symptoms of a heart attack, which include jaw pain, shortness of breath, backache, extreme fatigue, nausea and dizziness – far from the stereotypical image of a man clutching his chest in pain.
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We also can encourage women to talk about heart disease with friends and family. Organizations like WomenHeart offer peer-to-peer support, which is key to both a healthy recovery and fighting the stigma that still surrounds heart disease.
We need a national wake-up call. Federally supported campaigns, sustained over a period of years and properly funded, have proven to be highly effective at raising awareness of smoking, diabetes and other diseases and ultimately at improving health outcomes in the United States.
A similar public health education campaign about heart disease could raise awareness among the most vulnerable women nationwide, educate doctors and the public about gender differences in symptoms and treatment and would benefit the more than 43 million women in the United States living with or at risk for heart disease.
What are we waiting for?
COVID-19 is likely to be endemic, sticking around like the seasonal flu and creating one more dangerous variable for women’s heart health. Let us hope that this pandemic ends the historic neglect of this critical issue for women. There is no more time – and no more excuses.
Barbra Streisand is founder of the Barbra Streisand Women’s Heart Center at Cedars-Sinai in Los Angeles and co-founder, with Ronald O. Perelman, of the Women’s Heart Alliance. Dr. C. Noel Bairey Merz is director of the Barbra Streisand Women’s Heart Center, the Linda Joy Pollin Women’s Heart Health Program, and the Erika J. Glazer Women’s Heart Research Initiative at the Smidt Heart Institute at Cedars-Sinai, where she is a professor of medicine.