For decades, women had heart attacks in silence

2/16/2017, 6 a.m.
Cardiologist Dr. Nieca Goldberg had been taught that heart attacks were a man's problem, but that didn't stop her from ...

— Cardiologist Dr. Nieca Goldberg had been taught that heart attacks were a man's problem, but that didn't stop her from digging deeper.

In 1990, when she got her first job as a cardiologist, Goldberg suspected that a female patient had had a heart attack. The other doctors told the woman that she was probably "stressed out and needed a vacation," said Goldberg, now the medical director of the Joan H. Tisch Center for Women's Health at NYU Langone.

But Goldberg found a 99% blockage in one of the heart's most important arteries -- a blockage so dire that it is still commonly referred to as "the widowmaker."

"Even the terminology describing the lesion is so gendered," she said.

Experts like Goldberg have pointed out how sexism in the medical field has cost lives: Because research and treatments for heart disease were historically designed for men, many women and their doctors have missed the signs and risks of heart attacks, which can be very different between the genders.

'Bikini medicine'

Women suffered heart disease invisibly over much of the past century, said Dr. Nanette Wenger, a cardiologist at Emory University who began her medical career in the mid-1950s.

One reason for this, Wenger said, was that men developed heart attacks at younger ages.

"They were at the peak of their careers," she said. "They were visible. They were in the workplace."

Women, on the other hand, "were not paid much attention to," she said.

This trend was not limited to heart disease, as outlined by a 2010 report by the Institute of Medicine. According to Wenger, women in research have been neglected for all but their breasts and reproductive organs. Wenger calls this "bikini medicine."

"In the earlier years, even the basic research was done on male animals," she said. "It was cheaper."

A number of policies aimed at boosting gender equality in federally funded animal and cellular research have died in Congress. National recommendations like the 1977 research guidelines by the Food and Drug Administration "effectively excluded women of childbearing potential" from clinical studies. These guidelines were overturned in 1992 (PDF), and more recent policies have encouraged inclusion of women and their data.

The National Institutes of Health instituted a policy last year requiring that researchers specifically justify any research on only one sex. Today, women make up "roughly half" of all participants in clinical studies supported by the centers.

For men's heart health, a long history of research paid off in droves, said Wenger; heart disease among men dropped precipitously from the 1980s. But women would not see the same benefits until the 2000s.

The way to a woman's heart

Medicine was slow to adopt the concept of gender differences, Wenger said, but when it came to heart health, the differences were plentiful.

Nearly half of women in one study didn't have the classic warning signs of a heart attack. Instead of chest pain, they were more likely than men to describe symptoms like nausea and vomiting, trouble breathing and pain in the jaw, arm or back.