Heart disease impacts 2.6 million Canadians and ranks as the second highest cause of death in the country, with women being at a greater risk than men. A recent report from Heart and Stroke Canada for Heart Health Month in February points out the disparities women face in the prevention and treatment of heart attacks and strokes compared to other Canadians. The report reveals that women often lack awareness of their personal risk factors for heart disease and stroke and are frequently under-diagnosed or under-treated, despite these conditions being significant causes of early death among women in Canada. Approximately 50 percent of women who suffer from heart attacks have symptoms that go unrecognized.
The report emphasizes that individuals do not always have control over these health outcomes and highlights the influence of clinical and social determinants of health, such as healthcare access, food insecurity, insecure housing, race, racism, gender, and sexism, on the disease process. Historically, women have been largely excluded from clinical research, with two-thirds of studies not including women as participants or failing to consider sex and gender-related factors that influence disease risk or treatment effectiveness. This lack of representation in heart-related research has significant consequences for women and their communities across Canada.
Regarding heart health, there is substantial evidence that biological and social differences among women, men, girls, boys, and gender-diverse individuals lead to varied health outcomes and experiences with diseases. Both sex (biological differences) and gender (sociocultural factors) affect the likelihood of developing illnesses, access to and response to medical treatments, and frequency of seeking healthcare. Nowadays, many funding bodies, including the Canadian Institutes of Health Research (part of the Tri-Council Funding Program), require researchers to incorporate sex and gender considerations into research design, methodologies, and data analysis when applicable. Despite this, some groups of women who are highly susceptible to poor heart health outcomes remain underrepresented in research studies, public health initiatives, and clinical settings, which is detrimental to their wellbeing. For example, the Heart and Stroke Canada’s webpage highlighting women’s unique risk factors for heart disease and stroke specifically examines the roles of estrogen, birth control pills, pregnancy, menopause, and so-called “modifiable risks” like diet (which is often not as modifiable as we assume).
While these communications and data are grounded in empirical medical research, they may not effectively represent the unique challenges, needs, and experiences of diverse women’s sub-groups, such as lesbians, bisexual women, and transgender individuals. If these groups are not deliberately included in research designs, the resulting data may not accurately capture their distinct experiences and related risks for poor heart health. There are established and intersecting factors of oppression that impact heart health, and the diagnosis and treatment of cardio-metabolic conditions, affecting the success of prevention and treatment strategies. For instance, stroke risk prevention is influenced by numerous intersecting factors, such as race, income, and stress caused by lifelong systemic discrimination and harassment.
Current evidence supports a collective commitment to critically reflecting on the creation, execution, and assessment of interventions, programs, campaigns, communication, and education, alongside a greater representation of narratives from those less frequently highlighted. Advocated by the CIHR, specifically the CIHR Institute of Gender and Health, advancements are being made in reforming research study protocols, including sex- and gender-based data analysis and reporting of primary findings. With support from the Canadian government and health research organizations like Heart and Stroke Canada, there is a push for increased awareness of how sex and gender uniquely and intersectionally influence heart health. These endeavors are crucial in ensuring that heart and stroke data repositories account for the diverse needs and circumstances of Canadian women, enhancing our collective understanding and approaches to mitigating heart and stroke disparities.