State policy ignores heart disease in women, study finds

Policy report: Women's experience of heart disease is not sufficiently recognised and female symptoms are neglected in State…

Policy report: Women's experience of heart disease is not sufficiently recognised and female symptoms are neglected in State policy aimed at tackling the disease, according to a report by the Women's Health Council.

An analysis of Ireland's cardiovascular health policy, undertaken as part of a World Health Organisation project, found that there was an almost exclusive focus on typical male symptoms to the neglect of women's experience. The report states that this neglect of women's experience is "a significant cause for concern".

"The report focused almost exclusively on 'chest pain' to the neglect of any of the range of conditions women can experience as indicators of the disease, such as neck, shoulder or abdominal discomfort, dyspnoea, fatigue, nausea or vomiting," the Women's Health Council report states.

It also criticises the fact that there is "a significant gap" between the information regarding gender differences given in the State documents and "the practical recommendations made in Ireland's cardiovascular health strategy".

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The Women's Health Council is arguing that more consideration needs to be given to gender differences in all areas of health planning and that this would benefit both women and men.

The director of the council, Geraldine Luddy, said in a whole range of health areas, "whether you are a man or a woman significantly determines the symptoms you experience, and how the medical services treat you" but that despite this, "health policies and services are still slow to recognise and address these gender differences".

She also said clinical trials of drugs used on heart patients were generally only carried out on men. "It's presumed that if a tablet works on a man that it will work for women and that is not always the case. Drugs can have different effects on women because of lower body weight or because of interaction with hormones," Ms Luddy said.

The perception of heart disease as a male illness is also highlighted in the report. In fact, heart disease is the largest cause of death among both women and men in Ireland, representing 40 per cent of all deaths. It tends to affect women at a later age and more men die prematurely from the disease.

Irene Gibson, a specialist nurse with Croí, the west of Ireland cardiovascular foundation, agreed with the concerns raised by the Women's Health Council and said there was evidence that women do not receive the same standard of treatment as men. "Women who present with cardiac symptoms are only half as likely as men to undergo cardiac testing and they are less likely to get aggressive treatments," Ms Gibson said.

She said the traditional image of heart disease was at the core of the problem. For example, relatively few people realised that heart attacks and strokes killed twice as many women as all types of cancer combined. Campaigns had raised awareness of female cancers but not of the prevalence of heart disease, she said.

Ms Gibson said women also tended to wait longer than men before going to a doctor with symptoms of heart disease. "One reason for this is that they do not perceive themselves as possible candidates for heart disease," she said.

Very little research had been done on the signs and symptoms experienced by women. "The risk factors for men and women are the same, but the symptoms present differently and that is where the gap in the research is," she said. Only 10 per cent of women with cardiovascular symptoms presented with chest pain, and other symptoms included sore throat, neck pain, mid-back pain and nausea.

Integrating the Gender Perspective in Irish Health Policy: A Case Study is available on www.whc.ie