Most Canadian Women Are Unaware of the Symptoms and Risk Factors of Heart Disease

July 2014

The good news is that their hearts are in the right place. Women in Canada see themselves as their families’ “heart keepers,” playing a significant role in maintaining everyone’s heart health, whether it’s the food they serve, the physical activity they encourage, or the non-smoking households they preside over. In fact, two-thirds indicated that they have the greatest influence over their families’ health.

The not-so-good news is the first-ever Canadian survey of women’s knowledge and attitudes about heart health has found major gaps between what women think they know and what they actually know. Their knowledge of the symptoms of heart attacks and the risk factors that lead to them is not as good as they think it is, and their perception of their own risk of heart disease is significantly lower than their actual risk.

The national survey, published this month in the Canadian Journal of Cardiology, was carried out by the Canadian Women’s Heart Health Centre (CWHHC), a new initiative of the University of Ottawa Heart Institute that will be formally launched this September.

Lisa McDonnell, the study’s lead author and Program Manager for the CWHHC, said that she was surprised by the low levels of awareness about the risk factors for heart disease.

“The knowledge obtained from this survey,” said McDonnell, “Provides invaluable insight into what women want and need and will help us develop the Centre’s programs and services.”

It also highlights the fact that existing efforts at heart health promotion are not reaching most Canadian women.

Among the study’s findings:

  • Women know less about heart disease than they think they do. The average score on questions about heart health knowledge was only 15 out of 40. Only 25% of women scored in the high range. Forty-one per cent overestimated their knowledge levels, while fully 80% of those with a low knowledge score thought that they were moderately or well informed. Further, women diagnosed with heart disease were no more knowledgeable than women in general.
  • Women are not aware of the symptoms of heart attacks in women. The most common symptom for women is chest sensation or pain, yet only 53% recognized it as a symptom. Feeling flushed or in a cold sweat occurs in 40% of women’s heart attacks, but only 4% recognized it as a symptom. Because these symptoms are different than the “classic” heart attack symptoms exhibited by men, they often go unrecognized and women may delay seeking care when they experience an attack.
  • Women are generally aware of the role of body weight, physical activity and diet in heart disease, but show limited awareness of smoking, diabetes, high cholesterol or high blood pressure as risk factors. Smoking, diabetes and high blood pressure account for up to 53% of heart attacks, making this limited awareness of the medical risks (as opposed to lifestyle risks) both surprising and concerning.
  • Women generally perceive  risk of heart disease to be lower than it actually is. Medical risk: Sixty per cent of the women at high risk due to medical factors thought they were at low or moderate risk, and 15%  of those at moderate risk perceived themselves to be at low risk. Lifestyle risk: Similarly, 78%  of women at high risk due to lifestyle perceived their risk as low or moderate, while 31%  of those at moderate risk due to lifestyle perceived their risk to be low.
  • A significant proportion of women who have had a heart attack or stroke view the event as an episode that has been treated and is over. While 65%  of women understood their heart disease is a chronic condition that needs to be managed, 35% assumed it had been fixed and they could resume their pre-incident lifestyle.
  • Women strongly prefer to get their information about heart health from their physicians. Nearly two-thirds (62%) said they preferred to get information from their physicians, emphasizing the important role physicians can play in patient education.
  • Women see themselves as having the greatest influence over their families’ health and feel confident in their ability to play this role. Two-thirds of women (65%) see themselves in this role, but given the other survey results, many are overestimating how well they can do so.

The survey results regarding the role of women as the “heart keepers” of their families underscore the importance of the Canadian Women’s Heart Health Centre, said McDonnell.

“There are always one or two family members standing by the bedside [of a Heart Institute patient] and within five to ten years, they are often our patients too,” she said, because lifestyle risks are usually shared in families. “By helping women, we’re going to have an impact on their heart health and that of their kids.”

The CWHHC is targeting women who already have heart disease and those who are at moderate to high risk of developing it. The Centre has identified specific sub-groups of these women and will target efforts to reach each of them.

“We think it’s important to establish where we’re starting from,” added Robert Reid, PhD, Deputy Chief of the Division of Prevention and Rehabilitation, which houses the CWHHC. “This is really about how to help women take more control of their lives.”

The Centre will plan, implement and evaluate a range of programs before disseminating them across the country. McDonnell’s hope is that the Centre will eventually become a hub for improving women’s heart health and will be able to help centres across the country deliver programs to the women who need them.

AHA Statement Underscores Importance of Gender-Specific Diagnosis

In June 2014, the American Heart Association released a scientific statement highlighting the fact that diagnosing coronary heart disease in women has become more accurate due to recent gender-specific research. Previously, physicians used the male model of coronary heart disease to diagnose women, meaning that women who did not fit the model did not receive appropriate treatment, increasing their risk of a heart attack.

The statement underscored the importance of understanding clinically relevant differences between women and men and included recommendations for healthcare professionals when diagnosing heart disease in women.