When I started copyediting Carolyn Thomas’s manuscript A Woman’s Guide to Living with Heart Disease, I was excited. Having taught women’s health at Ohio State in 1996 and 1997, I knew that heart disease was women’s number-one health threat. And yet, there seem to be very few books out there on this topic. In the survey class I taught, we went over how women are often under-treated compared to men, for a variety of diseases and conditions. We discussed how we could take action to change this by educating ourselves and our families and friends and by supporting women’s health groups. In those days people did not look for information about health on the Internet, because it was so new, and many people did not have computers at home.
Here we are twenty years later, and information about women’s health and health in general is abundant on the Internet. But has this change made women and their doctors more aware of women’s heart issues? It seems that the answer is, for the most part, no. Carolyn Thomas informed me that at the national Canadian cardiovascular meeting she has attended for years, the number of papers (out of a total of over 700) presented about women’s heart issues has gone from “a few” in 2011 to “several” in 2017. So, researchers have been slow to jump on this potential bandwagon of important and life-saving health research. You might think that the other papers would apply to women’s heart health, since all the papers are about heart disease. But as women’s health advocates have known for decades, the vast majority of studies on heart disease include no women at all, and studies done only on men do not necessarily apply to women.
Other facts I was dismayed to learn while reading Carolyn’s wonderful book are that women are consistently underdiagnosed year to year, with only a few cities in the entire country having women’s heart clinics where cardiologists are expert in taking care of women. Although women often have different symptoms compared to men, even if women have the same symptoms, we are often dismissed as having an anxiety attack, having indigestion, or going through menopause. Because of this, women are undertreated and die at a much higher rate than men when they experience heart disease.
In addition, the tests given for heart disease do not work as well in women, so that even if a woman is actually having a heart attack, the tests can come back as “normal.” The reason these tests do not work as well in women is that the tests are created for men; women are rarely used in these research studies.
Another shocking fact that Carolyn lays bare is that pregnancy complications are a major risk factor for heart disease, and yet very few doctors and cardiologists are aware of this.
I can think of a lot of things that doctors, researchers, and medical schools could do about this tragic problem. They could start educating cardiologists about women and heart disease. They could start educating medical students about women and heart disease. Cardiologists could start educating themselves about women and heart disease. Researchers could start including women in their studies at the same rate as men.
But what you can do about this problem is to buy this user-friendly book for yourself, your sister, your mom, your doctor, and your female friends. Most women are at risk for heart disease. Some of the risk factors are pretty well known: lack of exercise; a diet high in trans fat and low in vegetables and whole grains; high blood pressure; smoking; having a certain type of high blood cholesterol; obesity. But a major risk factor for your heart health is being a woman who develops heart disease and goes to a doctor who is not familiar with heart disease in women. If we can’t educate every doctor today, we can educate ourselves, and Carolyn Thomas has given us the tools to do that. Using a conversational style, she has written a book we should applaud, for laying out the facts in a straightforward way and explaining in everyday language that we need to take charge of our own heart health care. Yes, after reading this book, you may know more than your doctor about women’s heart health. Give yourself and your loved ones that advantage!
Deborah Bors works in the manuscript editing department at Johns Hopkins University Press