Heart and Stroke Canada has released a new report for Heart Health Month in February. It highlights several disparities women continue to experience in the prevention and treatment of heart attack and stroke, in comparison to other Canadians. According to this report, women are generally unaware of their individual risk and risk factors, and are often under-diagnosed and under-treated.
This is despite heart disease and stroke being a key cause of premature death for women in Canada. Approximately 50 per cent of women who experience a heart attack had symptoms that went unrecognized.
This report also reminds us that these health outcomes are not always under the control of the individual, highlighting the role clinical and social determinants of health (which include health care, food insecurity, housing precarity, race/racism, gender and sexism) play in this disease process.
Two-thirds of clinical research has historically excluded women as research participants, or ignored the various factors that intersect with sex and gender in terms of disease risk or intervention evaluation. The absence of women in heart-related research continues to have life-altering effects on the lives of women throughout Canada and their communities.
Sex, gender and the heart
When it comes to heart health, it is important to note that there is significant evidence that biological and social differences between women, men, girls, boys and gender-diverse people contribute to differences in their overall health and experiences of disease.
Sex (biological attributes) and gender (sociocultural factors) influence our risk of developing diseases, how well we access and respond to medical treatments and how often we attempt to seek health care. Currently, several funding agencies, including the Canadian Institutes of Health Research (CIHR, a Tri-Council Funding Program), expect researchers to integrate sex and gender into their research design, including methodologies and data analysis where appropriate.
Despite this, sub-populations of women who are more likely to experience the effects of poor heart health are still not being seen in research studies, public health campaigns and clinical settings. This invisibility is killing them.
For instance, on the Heart and Stroke Canada website’s page on women’s unique risk factors for heart disease and stroke, specific attention is given to the role of estrogen, oral contraceptives, pregnancy, menopause and “modifiable risks” like diet (not always as modifiable as we like to think).
These communications, and data used to develop them, clearly rely on empirical medical research. However, they may miss the mark in terms of representing the unique risks, needs and experiences of sub-populations of diverse women like lesbians, bisexual women and transgender individuals. If these sub-populations are not purposefully included in research protocols, the resultant data may not reflect their unique experiences and related risks for poor heart health.
There are established and intersecting axes of oppression that impact heart health, assessment and treatment of cardio-metabolic conditions, including the success of treatment and prevention measures. For instance, risk prevention for stroke is affected by a variety of intersecting factors including race, income and stress caused by lifelong and systematic discrimination and harassment.
Current evidence supports collectively committing to critical reflection on the development, implementation and evaluation of interventions, programs, campaigns, communication and education, as well as the need to better represent the narratives of the outliers.
As advocated by the CIHR, and in particular the CIHR Institute of Gender and Health, advances are being made in terms of changes to research study protocols including sex- and gender-based analysis of data and in reporting of key findings.
The government of Canada in partnership with a number of health research organizations such as Heart and Stroke Canada is pushing for more attention to how both sex and gender uniquely and intersectionally affect heart health. These efforts are instrumental in how, for example, heart and stroke data repositories reflect the diverse needs and realities facing Canadian women. They also advance our collective understanding and approaches to addressing heart and stroke inequities.
Everyone has a role to play in advocating for women’s heart health. For example, by pushing for changes in clinical and research practices, in heart health promotion campaigns that reflect the diversity of women in Canada, and by ensuring that women are rendered visible in the process.
Jacquie Gahagan receives funding from the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, the Canadian Blood Services, and Research Nova Scotia.
Shannan M. Grant receives funding from Medavie, Tri-Council Funding Programs, Research Nova Scotia, IWK Health, Mount Saint Vincent University. She is affiliated with IWK Health, Dalhousie University, Dietitians of Canada, Diabetes Canada, People in Pain (PIPN), and Dr. Dayna Lee Baggley and Associates.