System failure: Women’s heart and brain health are at risk

Heart & Stroke report reveals significant inequities persist

Gaps in awareness, research, diagnosis and care threaten women’s heart and brain health according to a new Heart & Stroke report: System failure: Healthcare inequities continue to leave women’s heart and brain health behind. Many women are at further risk due to intersecting and overlapping factors such as race, ethnicity, Indigeneity, socioeconomic status, sexual orientation, geography, body size, and ability.

Women’s bodies are not the same as men’s – and neither are their lives. Biological differences mean that females face distinct risk factors, they are more likely to experience certain types of heart and brain conditions, and social differences affect their health. Some progress has been made but not enough and the consequences are stark: Heart disease and stroke claimed the lives of 32,271 women in Canada in 2019 – one woman’s life every 16 minutes.

There is a continued lack of awareness and understanding around women’s heart and brain health. Two-thirds of participants in clinical trials on heart disease and stroke have been men and when women are included, an analysis based on sex and gender is not always done. Half of women who experience heart attacks have their symptoms go unrecognized, and they are less likely than men to receive the treatments and medications they need or get them in a timely way.

Michelle Logeot experienced weakness and fatigue and was sweating a lot for months but her symptoms were dismissed. “I was misdiagnosed so many times; I was told I had anxiety, depression, menopause, a cold, flu, pneumonia, a prolapsed vagina, kidney stones. They wouldn’t listen to me until I flatlined.” Tests revealed she had multiple blockages in her coronary arteries and had to have a procedure to open three of her arteries with stents. She provides the following advice to women experiencing heart issues: “You have to advocate for yourself and if you have a doctor who dismisses you, then you have to find another one who will help.”

According to the latest Heart & Stroke national polling data, nearly 40% of people in Canada do not realize that heart disease and stroke are the leading cause of premature death in women yet 75% think we should be more concerned about women’s heart and brain health.

Women face distinct risk factors for heart disease and stroke – and at different points in their lives including pregnancy and menopause. Pregnancy can lead to hypertension and gestational diabetes, both of which increase the lifetime risk of heart disease and stroke. Additionally, as they age, women acquire cardiovascular risk factors at a faster rate than men. “Better screening, education and follow-up during and after pregnancy could help many women reduce their risk of heart disease later in life,” says Dr. Padma Kaul, a Heart & Stroke funded researcher at the University of Alberta.

Certain types of heart conditions are more common in women, and women can be impacted differently by heart disease and stroke. Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a type of heart attack that is at least twice as prevalent in women than men. Spontaneous coronary artery dissection (SCAD) is a common cause of heart attacks in younger women and during pregnancy or childbirth. Women who experience STEMI or NSTEMI – two of the three main types of heart attacks — are more likely than men to die or develop heart failure. Women who experience stroke are at higher risk of dying than men — and if they survive, their outcomes are worse.

“We simply do not know how to treat forms of cardiovascular disease that are more common in women,” says Dr. Husam Abdel-Qadir, Women’s Heart and Brain Health Chair at Women’s College Hospital in Toronto.

Gender roles and social expectations can create further barriers to care and support as women tend to prioritize the health needs of their family over their own, take on greater caregiver responsibilities and have more challenges advocating for themselves.

Greater inequities

All women face inequities, but some face greater inequities than others. Every woman is an individual and there are intersecting cultural and social factors and power dynamics that put some women’s heart and brain health at greater risk than others.

  • Women living with low socioeconomic status are more susceptible to heart disease and stroke than those with higher incomes and on average women earn less than men. Low income also affects access to education, adequate housing, child care, a nutritious diet and health care. “The stress related to living on or at the poverty line has a huge impact on women’s health,” says Dr. Inderveer Mahal, a family physician who works with women in Vancouver’s Downtown Eastside.
  • Ethnicity can influence genetic predispositions to certain conditions and risk factors. Research shows that South Asian, Afro-Caribbean, Hispanic and Chinese North American women have greater risk factors for cardiovascular disease. Language and cultural barriers and institutional racism pose significant roadblocks to people from racialized communities getting the care they deserve.
  • Indigenous people in Canada are more likely to be at risk for or currently living with heart disease and stroke compared to the general population. For some Indigenous groups, the death rate from heart disease and stroke is also higher, particularly for women and younger age groups. The lifetime risk and prevalence of diabetes is higher in Indigenous people compared to the general population of Canada — particularly for women. Indigenous people can face extensive discrimination within the healthcare system and as a result, are less likely to seek care. Intergenerational trauma caused by Canada’s residential school system continues to affect their health in profound ways.
  • People living in northern, rural and remote areas are more likely to experience heart conditions and stroke — and more likely to die as a result. Challenges to care include limited access to ambulances and emergency care, prevention and screening and recovery support. People often have to travel significant distances for care – which is time-consuming and expensive.
  • There is mounting evidence that 2SLGBTQ+ people as a group face more health inequities than their cisgender, heterosexual peers, likely due to a variety of factors. Dr Jacqueline Gahagan, Associate Vice-President Research, Mount Saint Vincent University, explains how “minority stress” negatively impacts cardiovascular health in 2SLGBTQ+ communities. “It is not that your heart is a 'gay shape' and therefore pumps blood differently. It is the overarching notion that 2SLGBTQ+ people live with discrimination, harassment and the threat of violence at a much higher rate than cisgender, heterosexual folks do.” 
  • Women with disabilities have a higher risk of adverse cardiac events, older patients are often excluded from clinical trials, and people with a high body mass index are significantly more likely to report discrimination in health care.

“Transforming the state of women’s heart and brain health will involve changing policies, systems, attitudes and behaviours. It will take a massive collaborative effort to break down the barriers that create inequities,” says Doug Roth, CEO, Heart & Stroke. “Heart & Stroke is committed to working with our partners to ensure all women in Canada receive the care and support they need.”

About Heart & Stroke

Life. We don’t want you to miss it. That’s why Heart & Stroke has been leading the fight to beat heart disease and stroke for 70 years. We must generate the next medical breakthroughs, so Canadians don’t miss out on precious moments. Together, we are working to prevent disease, save lives and promote recovery through research, health promotion and public policy. @HeartandStroke

Contact information

Stephanie Lawrence
613 290 4236