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May 2020 − Exploring Life
When women suffer a heart attack, it often goes unrecognized. Men set the standards in medicine – in diagnostics as well as therapy.
Why is that?
A 40-year-old hairdresser suddenly complains of nausea, chest pains and copious sweating while at work. She goes to the bathroom and hopes that things will improve. Her family doctor diagnoses stomach upset. Days pass. Following a blood pressure measurement at a local pharmacy, a heart attack is diagnosed in a cardiac outpatient clinic. Two weeks had passed!
This typical example shows that on the one hand, women tend not to take their heart problems seriously. After all, they believe that a heart attack is only accompanied by a strong sensation of tightness in the chest as it is experienced by men, as well as with pain radiating into the left arm. Further-more, medical professionals are less likely to suspect a heart attack in a woman, which is why emergency procedures are often initiated too late in the case of female patients. Studies show that emergency first responders are also less willing to perform heart pressure massage on a woman – likely due to uneasiness surrounding the female breast. The consequence: more women than men die following a heart attack.
According to statistics, the chances of recovery from diseases of the heart and circulatory system are about half as good for women as they are for men. The clinical picture manifests serious differences: the sudden cardiac arrest of an athlete mainly affects men, while stress-induced heart disease – by now well-known as the “Eve attack” – is 90 percent a women’s issue. It is a fact: women’s illnesses are not quite the same. Autoimmune diseases, depression and osteoporosis are considered classic women’s illnesses. Even in the case of gastrointestinal cancer, recently discovered gender-specific differences revealed that women continue to be at risk into old age. For this reason, Professor Thomas Schiedeck, President of the German Society for General and Visceral Surgery, demands a shift in the current statutory provision which applies to screening for gastrointestinal cancers: men would be recommended to be screened even prior to turning 50, whereas women would be screened well past their 75th birthdays.
“The symptoms experienced by women frequently do not correspond to what is written in the very male-centered textbooks”, explains Dr. Vera Regitz-Zagrosek, Professor of Cardiology. The 66-year-old is considered a pioneer; she initiated the first German Institute for Gender Research in medicine. It was the year 2003, at the Charité Hospital in Berlin, two years after Sweden had founded the first European Institute for Gender Medicine. In Germany, gender medicine still leads a niche existence. Scandinavian countries and Switzerland, as well as Canada and the United Nations, are miles ahead. In these places, for example, research proposals are only approved if they consider gender-specific differences.
Medicine – a man’s world
It can be a matter of life and death. Even with medication, there is that little difference – with, at times, serious consequences. Digoxin, a common medication used to treat cardiac insufficiency, may even reinforce heart problems in women.
Medications against high blood pressure exhibit stronger sideeffects in women. And while common Aspirin is an effective prophylactic against heart attack in men, it does not work in women. The sleeping medication Zolpidem causes a strong hangover in women – women are only prescribed half the dose. To this day, most package inserts do not address this issue.
The reasons are of a biological (see info box) as well as political nature: the majority of doctors are male. Women are also underrepresented in guideline committees where treatment standards are defined. Furthermore, since men dominate the scientific societies, research continues to be a man’s world. It is therefore no surprise that it is mainly young male mice which are tested in pharmaceutical studies, and that medication is optimally tailored to young men. Vera Regitz-Zagrosek emphasizes: “Gender medicine is not intended to be women’s medicine.” The goal is to develop better medications for men and women.
Biological differences such as height, fat content, hormones and enzyme structure are among the reasons why medications are taken up differently by women. Even the journey of a substance to the liver is considerably longer in a woman. In addition, medications react differently with the sex hormones – testosterone in men, estrogen in women. There is also considerable interplay between biological (“sex”) and socio-cultural (“gender”) criteria, including toxins, smoking and stress. “Overall, female cells deal better with environmental influences”, explains Vera Regitz-Zagrosek, Professor of Gender Medicine. Thanks to the double X chromosome, female cells developed protective processes, which should now also be harnessed for men.