Leading cardiology clinicians and researchers have made a call to action to address widespread sex discrepancies in all aspects of heart disease.
The Heart Foundation Women in Heart Disease Forum 2019 held in Sydney heard that the scale of the problem went far beyond underdiagnosis and delayed treatment of heart disease in women. Sex differences in heart disease encompassed under-representation of women in clinical trials, lack of sex-specific clinical guidelines and risk calculators, under appreciation of the cardiovascular consequences of conditions such as pregnancy and pre-eclampsia, and under-representation of women in cardiology.
Professor Robyn Norton, Principal Director of the George Institute for Global Health said a fundamental problem was that sex and gender were often not considered as factors in research, with women accounting for only 20-30% of participants in studies. She explained that sex differences related to biological characteristics whereas gender differences related to factors such as socioeconomic and cultural differences.
For both there was a paucity of data in all aspects of heart disease in women, including differences in epidemiology, characteristics and symptoms, as well as risk factors, prognosis and outcomes of treatment.
“There’s a lot that we need to be doing in Australia if we are going to embed the concept of sex and gender in our research and practice,” she said.
Widespread implementation would require such changes to be adopted by bodies including medical schools, research funding bodies, medical journals, regulatory authorities, guideline authors and ethics committees as well as industry, Professor Norton suggested.
Professor Clara Chow, a cardiologist at the University of Sydney, presented data on the sex differences in the management of STEMI in Australian hospitals. Women had lower rates of revascularistion, were less likely to receive statins or referral to cardiac rehab at discharge and had higher mortality rates than men at six months.
Professor Norton noted that similar findings on undertreatment from the UK had translated into 8000 additional deaths among women from heart disease over a ten year period