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Heart Disease is a Bigger Threat to Women Than Breast Cancer – How Gender-Specific ECG Algorithms May Help Predict Risk

Women are more likely to die after a heart attack than men and more women die from heart disease than any other diagnosis; gender-specific ECGs may to help predict the risk of a cardiac event.

Women with an ECG being transported by two clinicians

When people think of things women should worry about as they age, cancer tends to be one of the first things mentioned. While breast cancer is deadly and something women should be screened for – heart disease is the number one killer of women.

When looking at total deaths, more men die from heart disease making it a disease often thought of as a man’s issue. But more women die from heart disease than anything else.

And oftentimes, women with the highest risks have the least amount of knowledge about things like heart attack symptoms 1.

Women are also more likely to die after a heart attack compared to men, with many different theories as to why.2 Factors including gender-specific hormones, comorbidities, lack of aggressive care, and lack of awareness all contribute to a woman’s mortality from heart disease and cardiac events 2.

Today’s article covers the statistics surrounding women and heart disease, known risk factors, and how gender-specific screening can help predict cardiac risk.

Breast Cancer Versus Heart Disease – Which is Responsible for More Deaths?

Heart disease effects the lives of women across the globe. While many campaigns exist to bring awareness to breast cancer screening and testing, the truth is heart disease poses a much greater threat to women.

Compared to breast cancer, heart disease kills twice as many women in the UK 3 . In the U.S., one out of 31 American women die from breast cancer while heart disease causes one out of every three deaths 4.

It’s estimated one in 16 women who are over 20 years old have coronary heart disease making it something women of all ages should be aware of 5.

Heart Disease Risk Factors for Women

In addition to a lack of awareness, there are other risk factors that increase a woman’s risk of heart disease. Gender-specific risk factors include 5, 6 :

  • Contraception use
  • Early menarche
  • Early age of pregnancy
  • Early menopause
  • Atypical heart attack symptoms
  • Undertreatment

Other lifestyle risk factors that increase a person’s risk for heart disease including smoking, stress, and obesity are often more present in women than in men.5 Not only that, but diagnoses like hypertension and diabetes can impact arterial health more severely in women.5

When looking at diabetes specifically, which is a known risk factor for heart disease, diabetes increases a woman’s risk 44% more than a man’s heart disease risk with diabetes.7

On top of the physiological risk factors, women are less likely to focus on themselves. It’s been shown women prioritize the health of their family members over their own which can lead to symptoms being missed or brushed aside.5

All of these things combined illustrate how women have a substantial risk for heart disease as they age. With underdiagnosing and lack of gender-specific screening, many women could be at risk, or have heart disease, and not even know it.5

This highlights the importance of taking gender into account when it comes to heart health – especially screening. This includes assessing for gender-specific symptoms and gender-specific presentations on things like an ECG.

Do Men and Women Have Different ECG Presentations?

ECGs are a standard screening and diagnostic tool when it comes to evaluating a person’s cardiovascular status. ECG settings aren’t typically programmed differently for men and for women, nor are the results interpreted differently.

More and more studies are showing that certain ECG readings can actually mean different things based on gender, including predicting cardiac events.

A study with over 800 patients found numerous prognostic indicators in female ECG readings compared to men when it came to predicating risk of cardiac events 7 .This study focused on people who were recently post-myocardial infarction (MI). When women had ST segment elevation found on their ECG 5-7 days post-MI, they had a higher risk of recurrent cardiac events.8

This finding is note-worthy because men had the exact opposite prognostic indicator. Rather than elevation, when men had ST depression, this was a prognostic indicator of recurrent cardiac events.8

Gender-Specific ECG Algorithm

With the knowledge that certain ECG readings impact women differently than men, gender-specific ECG algorithms have been created. These algorithms help alert clinicians when a particular reading could indicate a potential impending cardiac event.

A 2014 study applied an ECG algorithm based on both gender and age. The algorithm analyzed over 1,300 patients with an acute MI 8 .By adjusting ST elevation thresholds based on the information, relative sensitivity was improved by 25% while maintaining a specificity of 98%. Researchers illustrate with this study how adjusting parameters based on gender and age can improve ECG interpretation.9

GE Healthcare has been utilizing gender-specific criteria when it comes to ECG interpretation since 2000 9. These algorithms help clinicians identify clinically significant changes which drive prompt decision making to improve clinical outcomes. Sensitivity for detection of acute MI is improved from 42% to 48% with these algorithms in place highlighting the importance of gender-specific cardiac screening and care 10.

While improvements in screening are only a small factor when it comes to improving women’s outcomes related to heart disease, it is a step in the right direction which will hopefully pave the way for more personalized and improved patient outcomes.

Summary

  • Heart disease kills more women than any other disease, including breast cancer
  • Risk factors including hormones, comorbidities, and lack of awareness all contribute to the high prevalence and mortality in women due to heart disease
  • Men and women have different prognostic indicators present on an ECG highlighting the need for gender-specific parameters
  • Gender-specific ECG algorithms have been shown to improve sensitivity and can help play a role in more accurate risk assessment when it comes to cardiac events

References

[1] Flink, L et al. (2013). Women at risk for cardiovascular disease lack knowledge of heart attack symptoms. Clinical Cardiology. 36(3). 133-8

[2] Anderson, D & Pepine, C. (2007). Gender differences in the treatment for acute myocardial infarction: bias or biology? Circulation. 115(7). 823-826.

[3] British Heart Foundation. (2022). Heart Matters. Twice as deadly as breast cancer.

[4] American Heart Association. (2022). About Heart Disease in Women.

[5] Benjamin, E et al. (2019). Heart disease and stroke statistics-2019 update: a report from the American Heart Association. Circulation. 139. E1-e473.

[6] Woodward, M. (2019). Cardiovascular disease and the female disadvantage. International Journal of Environmental Research and Public Health. 16(7). 1165.

[7] Mieszczanska, H et al. (2008). Gender related differences in electrocardiographic parameters and their association with cardiac events in patients after myocardial infarction. American Journal of Cardiology. 101(1). 20-24.

[8] Xue, J & Farrell, R. (2014). How can computerized interpretation algorithms adapt to gender/age differences in ECG measurements? Journal of Electrocardiology. 47(6). 849-55.

[9] GE Healthcare. (2022). Marquette 12SL ECG Analysis Program: Physician's Guide.

[10] Wright, R et al. (2001). Women with acute anterior myocardial infarction have less precordial ST elevation than men independent of age of presentation. J Am Coll Cardiol. 37(2001): 361A.

  • Circulatory
  • ECG
  • Cardiac care
  • Clinical