A new report from the Heart and Stroke Foundation of Canada is highlighting 'significant inequities' in women's heart and brain health care that is disproportionately affecting racialized and Indigenous women, members of the LGBTQ2S+ community and those living with low socioeconomic status, among others.
The report, released Wednesday, says gaps in research and care – compounded by a lack of awareness of the distinct heart disease and stroke risk factors women face -- are putting lives at risk.
The report says that, in general, women who have a heart attack are less likely than men to receive the treatments and medications they need or get them in a timely way, and they are more likely than men to die in the year afterwards. In 2019, 20 per cent more women in Canada died of heart failure than men, and 32 per cent more women died of stroke than men, according to Heart and Stroke. The report says heart disease and stroke claimed the lives of more than 32,200 women in 2019 – or one life every 16 minutes.
Heart and Stroke said that women referred to in this report include cisgender and transgender women as well as trans and non-binary people “with shared experiences who may not identify as women.”
The report highlights groups of women that face greater health inequities than others, including racialized women, Indigenous women, women in the LGBTQ2S+ community, women of lower socioeconomic status, women with disabilities, and women living in remote areas.
BIPOC (Black, Indigenous and People of Colour) women often have predisposed risks for cardiovascular disease, but Canadian guidelines to understanding these risks are not based on ethnicities, the report says. According to a 2014 report, in collaboration with the Heart and Stroke Foundation, researchers found that out of 1,000 pregnant women in Ontario, gestational diabetes is twice as common in South Asian women than it is in white women of European decent. Similarly, Afro-Caribbean, Hispanic, and Chinese North American women have greater risks of heart disease because of predispositions many aren`t aware about.
Women of lower socioeconomic status and those who live in rural areas also face greater health risks because of their lack of access to health resources, education or nutritious, affordable food on a daily basis.
Additionally, women and people with shared experiences who may not identify as women in the LGBTQ2S+ community not only face increased health risks but also face discrimination when seeking medical care. According to a TRANS Pulse survey, 44 per cent of of trans people in Ontario said their health needs were unmet in 2019, as many of them reported avoiding the emergency room or seeing their family physicians because of past negatives experiences where they felt dismissed or misunderstood.
Dr. Alexandra Bastiany, the first Black woman in Canada to become an interventional cardiologist, said the multiple layers of a woman's life play a huge role in the way heart disease is diagnosed and treated.
"Being a woman is one thing, that's already a risk factor for not receiving the right treatment but that's without even counting all the other stuff that can affect our patients," Bastiany told CTVNews.ca in a phone interview on Jan. 20.
GAP IN UNBIASED MEDICAL TRAINING
According to the report, nearly 40 per cent of people in Canada do not realize that heart disease and stroke are the leading cause of premature death in women. This is especially dangerous for BIPOC women, the report says, as racialized women’s health can be affected by several factors including racism, historical trauma, language and cultural barriers.
Bastiany, who practices out of Thunder Bay Regional Health Sciences Centre, said her switch from working at a clinic in Montreal to a more remote community in Northern Ontario has brought her more awareness of the Indigenous communities and needs of Indigenous women there.
"Because of past experiences and the historical trauma, there's definitely a mistrust in the system and I am working to try to bridge that and try to make it better on a small scale," she said.
Bastiany, said there needs to be more awareness and hands-on experience for health-care providers on how to approach BIPOC patients. This would not only make them feel safe in their doctors’ care but build trust with the medical system that has failed them in the past, she said.
"There's so much space to make the training better and I don't think that online modules are enough. I think that there needs to be hands-on, real life experience that we need to have at the start of training because that creates a better physician," she said.
HOW WOMEN CAN ADVOCATE FOR THEMSELVES
The report also included various testimonies of women who either weren't able to recognize the symptoms of heart disease in themselves or were dismissed by their health-care provider.
Women face greater cardiovascular health risks due to factors such as pregnancy, which can lead to high blood pressure, or Polycystic Ovarian Syndrome (PCOS), which can lead to a greater risk of obesity and potentially lead to heart disease or stroke. Additionally, some heart conditions that can occur in men are more prevalent in women, such as takotsubo cardiomyopathy – commonly known as broken heart syndrome -- which can be triggered by stress.
In these instances, Bastiany said it's imperative for women to understand any pre-existing risk factors in their health and recognize any abnormal patterns to ensure they get medical attention as soon as they need it.
According to the report, heart disease and stroke in women may not present itself as intense chest pain during a heart attack, especially because women are more likely to experience several symptoms at a time. Shortness of breath, nausea, vomiting or discomfort in the neck, jaw, shoulder, upper back or upper belly are more common in women.
Many women are unaware of the risks they face for heart disease -- such as pregnancy, age or menopause -- which can lead to hypertension and an increased risk of stroke later in life, which is why screening and education is key, Bastiany said.
"It's important that people know their risk factors and know about their medical situation, so that they can advocate for themselves and know when something is wrong," she said.
Additionally, she said women shouldn't be afraid to seek a different health opinion if they feel like they're being dismissed by their health-care provider.
"Patients shouldn't be scared to ask for a second opinion. When you feel like the medical staff is biased, or is not really paying attention or listening to what they're saying, I think that it's very OK to ask for someone else," she said.
While the Heart and Stroke Foundation says there have been improvements over the last five years in including women’s needs in cardiovascular health studies and treatments, there is still work to be done. In particular, the organization is calling for the improvement of women`s heart and brain health guidelines on diagnosis and rehabilitation, based on women`s specific needs. Additionally, a focus on education and awareness in the medical field and among women in general is needed so patients can feel encouraged to speak to their health care providers without restricting themselves, the report says.