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Behind the Research: Do women still get the ‘short end of the stick’ when it comes to heart attack care?

Dr. Mina Madan
Written by Katherine Nazimek

A new study of younger heart attack survivors found while the health care system delivers high quality care, disparities remain between men and women.

Investigators from Sunnybrook Health Sciences Centre studied 38,071 heart attack survivors aged 18 to 55 years who were hospitalized in Ontario, Canada in a 10-year period (2009-2019). They discovered that young women are more likely to be readmitted to hospital following a heart attack compared to young men, and that risk factors for heart disease for young women continue to rise.

Their findings appear in the Canadian Journal of Cardiology published by Elsevier.

Dr. Mina Madan, lead investigator and cardiologist at Sunnybrook, shares insight on what this latest research could mean for the health care system and what younger women can do to prevent heart disease.

What inspired you to pursue this research?

Dr. Madan: There’s been a lot in the literature about how women are getting the short end of the stick: they don’t get to the hospital on time, and when they do arrive maybe they aren’t taken seriously. Or there are delays in diagnosis and procedures. I wanted to look with an objective eye as to what’s happening now in Ontario.

How are younger women doing compared to younger men?

Dr. Madan: The good news is that younger women are universally getting coronary angiography when they come to the hospital with a heart attack, similar to their male counterparts; and mortality rates are now very similar. The bad news is that women have more cardiac risk factors relative to men, and they’re being readmitted to hospital for both cardiovascular and non-cardiovascular causes at a much higher rate.

The reason they are being readmitted to hospital or may not be receiving certain procedures could be due to the cause of their heart attack. While coronary artery disease or blockages in the heart are more common for men, younger women are more likely to experience heart attacks from conditions caused by a tear in the coronary artery (SCAD, Spontaneous Coronary Artery Dissection), stress (stress cardiomyopathy), or a dysfunction of tiny blood vessels (micro vascular dysfunction), for example.

What is really concerning, is that our findings showed younger women have more cardiac risk factors. Over the 10-year period, we discovered a 10 per cent increase in the rate of diabetes in younger women, compared to a four per cent increase in younger men. This underscores the need for ongoing efforts from the entire health system to improve our prevention strategies.

What can the health care system do better?

Dr. Madan: Overall, the health care system is providing high-quality of care for both men and women following a heart attack, but with the significant disparities in hospital readmission and comorbidities, more needs to be done. Perhaps women have different needs after they go home from a heart attack. They may benefit from more frequent or earlier check-ins after hospitalization, or earlier intake into cardiac rehabilitation programs. It may also help to screen for heart conditions and risk factors earlier in a woman’s life, maybe in their 30s or 40s to help prevent a bad outcome.

What can women do to help prevent heart disease?

Dr. Madan: People, regardless of their sex, need to take care of themselves and make sure that they are living the best life possible in terms of physical activity, eating properly, reducing stress, and avoiding smoking. Speak to your doctor if you are concerned about your heart health, even if you consider yourself too young.

» Read the full study in the Canadian Journal of Cardiology

This study identifies sex and gender as reported by the patient. For the purpose of this study, “young” is defined as individuals aged 55 years or younger.

About the author

Katherine Nazimek

Katherine Nazimek is a Communications Advisor at Sunnybrook.

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