Saturnino P. Javier, MD, FPCP, FPCC, FACC
Dr. Saturnino P. Javier is an interventional cardiologist at Makati Medical Center and Asian Hospital and Medical Center. He is a past president of the Philippine Heart Association (PHA) and past editor of PHA’s Newsbriefs
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Before I bear the brunt of the hatred and anger by many women colleagues, patients and friends – allow me to qualify what I meant by ‘difficult’. Women [with heart or cardiovascular disease] can be difficult … to recognize and treat. This is not an opinion, but a fact.
In May 2017, the World Heart Federation (WHF) has emphasized in a statement the basic truth that cardiovascular disease (CVD) does not just affect men, but also women, and in some instances, the effects in women can be worse, or outright catastrophic. It is the number one killer of women, with over two million premature deaths each year.
More recently, in a statistical update and fact sheet released this year by the American Heart Association, the data culled from 2016 show that females represented nearly 50 percent of all deaths from cardiovascular disease. One of the most sobering reminders is that cardiovascular disease caused more deaths than the combined deaths from cancer, accidents and diabetes. These statistics that highlight the number of women dying from cardiovascular disease should be a real cause for alarm. It should awaken health professionals to the dangers of cardiovascular disease affecting women – and the manner by which society and women themselves recognize the impact of these statistics.
The World Heart Federation also emphasized that women present with different symptoms than men. This diverse and atypical presentation among women can lead to underdiagnosis and undertreatment. The risk profiling of women can be largely flawed because of the underestimation of the risk of dying among women afflicted with cardiovascular disease.
We sometimes refer to it pejoratively in the colloquial native Filipino language—”Mahirap ispelingin ang mga babae?” (Women can be hard to read or understand.) Quite appropriately, this difficulty and complexity in reading and understanding women extends to their medical symptoms and disease presentations. Even worse, the problem is compounded by the different progress and course of cardiovascular disease among women. Gender differences in prognosis and outcomes of cardiovascular disease is well recognized.
The WHF enumerated a number of distressing findings: younger women who have a heart attack have higher mortality than men of the same age; women are more likely than men to become disabled after a stroke; women with diabetes have higher risk of dying than men with diabetes; after a stroke, women are more likely to experience serious problems compared to men. Women themselves underestimate their own risk of being adversely affected by a serious cardiac condition. Women have this overwhelming fear of cancers – like breast cancer or uterine cancer, yet the statistics clearly document that dying from heart disease is much more likely.
Cultural barriers play a crucial role in healthcare delivery for women. In his blog for the London School of Economics and Political Science, Sabin Muzaffar argues that culture plays a very important role in setting gender norms – where the norms are heavily against women. The division and delineation of roles in the family is clear – the husband is supposed to earn and provide for the family while the woman has to take care of the house. The woman assumes role of home caregiver – a job that does not pay – unlike the men. Muzaffar delineates dependency of the non-earning woman on the men in her life on many occasions – on the father in her early life, on the husband in mid-life and on a son in her later years. The definition of roles is too clear that a breach by either party is oftentimes not possible.
In the Philippines, actual and real clinical situations demonstrate how this patriarchal mindset can be operational. Like in many other societies and cultures around the world, the woman (wife) prioritizes the husband’s care and treatment – many times to the detriment of her own health. Women attend to and care for their children, in-laws, grandparents – even the household personnel. In the hierarchy of healthcare priorities, one can always surmise that the wife is not high up there.
We welcome advocacies that seek to alter and modify misconceptions and flawed practices related to women’s healthcare. Already, the Philippine Heart Association has established a Council on Women’s Health several years ago that seeks to improve society’s perception of women’s heart health and promote heart wellness among women. A number of tertiary centers have launched specialty units dedicated solely to women’s health.
There are certain ‘norms’ that should not be allowed to remain as such. The norm that relegates women to the background in every aspect of healthcare ought to be changed.