Transcript: Caring for a Woman's Heart | Apr 11, 2018

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a dark gray suit, a white shirt and a polka dotted blue tie.

A caption reads “Caring for women’s hearts.”

The caption changes to “Twitter: @spaikin, @theagenda.”

Steve says ACCORDING TO THE HEART
AND STROKE FOUNDATION'S 2018
HEART REPORT, FIVE TIMES AS MANY
WOMEN IN CANADA DIE FROM HEART
DISEASE AS FROM BREAST CANCER.
THE FACT THAT THAT WILL COME AS
A SURPRISE TO MANY PEOPLE MAY
POINT TO PART OF THE PROBLEM.
JOINING US NOW TO GET A BETTER
HANDLE ON THIS:
IN THE NATION'S CAPITAL:
DR. THAIS COUTINHO, SHE'S THE
CHAIR OF THE CANADIAN WOMEN'S
HEART HEALTH CENTRE AND CHIEF OF
THE DIVISION OF CARDIAC
PREVENTION AND REHABILITATION AT
THE UNIVERSITY OF OTTAWA HEART
INSTITUTE.

Thais is in her thirties, with shoulder length straight brown hair in a side part and wears a red top and a black blazer.

Steve says AND HERE IN OUR STUDIO:
DR. PAULA HARVEY,
PHYSICIAN-IN-CHIEF IN THE
DEPARTMENT OF MEDICINE AND
DIRECTOR OF CARDIOVASCULAR
RESEARCH AT WOMEN'S COLLEGE
HOSPITAL;

Paula is in her forties, with short wavy red hair and wears a black top, a red and black houndstooth print jacket with black sleeves and black leather shoulder pads and a silver choker necklace.

Steve says AND SHERRY GRACE, SENIOR
SCIENTIST WITH THE UNIVERSITY
HEALTH NETWORK AND A PROFESSOR
AT YORK UNIVERSITY.

Sherry is in her forties, with long wavy red hair in a side part and wears a blue dress, blue blazer and blue necklace.

Steve says WE'RE SATELLITE DELIGHTED TO
WELCOME YOU TWO IN OUR STUDIO
AND DR. COUTINHO IN OTTAWA TO
OUR PROGRAM TONIGHT.
LET ME SHARE THIS EXCERPT FROM
THE HEART AND STROKE
FOUNDATION'S HEART REPORT, AND
THIS WILL GET US OFF TO THE
RACES.
SHELDON, THANK YOU.

A slate appears on screen with a caption that reads “Heart disease in Canada. Leading cause of premature death for women. Two-thirds of research focus on men. Early signs missed in most women. Women more likely to get second heart attack. Heart and Stroke Foundation’s Heart report (2018).”

Steve says LET'S GET INTO THIS.
THAIS, WHY ARE HEART ATTACKS
DEADLIER FOR WOMEN THAN FOR MEN?
LET'S START THERE.

The caption changes to “Caring for women’s hearts. A deadly gap.”

A split screen shows Steve to the left and Thais to the right with a caption that reads “Ottawa, Ontario.”

The caption changes to “Thais Coutinho. University of Ottawa Heart Institute.”

Thais says MIGHT AS WELL START WITH THE
MILLION DOLLAR QUESTION, RIGHT?
I THINK IF WE ALL KNOW THE RIGHT
ANSWER TO THIS, WE WOULDN'T BE
HERE TALKING ABOUT THIS, WE
WOULD HAVE SOLVED THE PROBLEM.
JOKING ASIDE, IT'S PROBABLY A
MULTIFACTORIAL ISSUE.
YOU MENTIONED YOURSELF THAT
TWO-THIRDS OF RESEARCH IN
CARDIOVASCULAR DISEASE HAVE
FOCUSED ON MEN.
SO A LOT OF WHAT WE KNOW ABOUT
CLINICAL MANIFESTATIONS AND WHAT
WORKS AND WHAT DOESN'T WORK IT'S
VERY APPLICABLE FOR MEN, NOT
NECESSARILY APPLICABLE FOR
WOMEN.
IN ADDITION TO THAT, THERE'S
ALSO THE MATTER OF PATTERN
RECOGNITION.
THE SYMPTOMS THAT WE LEARN AS
HEALTH CARE PROVIDERS IN SCHOOL
AS WE'RE STUDYING TO FIND OUT
WHAT DOES A HEART ATTACK LOOK
LIKE, AND SOMETIMES THE WOMEN IN
THE COMMUNITY WHAT THEY HEAR
ABOUT WHAT THE SYMPTOMS SHOULD
BE FOR WHEN THEY'RE HAVING A
HEART ATTACK, WELL, THOSE
DESCRIPTIONS WERE MADE BASED ON
MEN.
SO SOMETIMES WOMEN PRESENT IN
DIFFERENT WAYS AND IT MAKES IT
HARDER FOR THE WOMAN TO
RECOGNIZE SHE IS HAVING A HEART
ATTACK, IT MAKES IT DIFFICULT
FOR THE PROVIDER TO RECOGNIZE
IT, AND THAT, COUPLED WITH THE
LACK OF ROBUST SCIENTIFIC DATA
TO SUPPORT THE DIAGNOSTIC AND
THERAPEUTIC EFFECTS, I THINK ALL
OF THIS PUT TOGETHER HAS HELPED
LEAD TO THE HIGHER DEATH RATES
AFTER A HEART ATTACK FOR WOMEN
THAN MEN.

Steve says PAULA, LET ME ASK
YOU THE OBVIOUS FOLLOW-UP
QUESTION: IF THIS IS SUCH A
STARK SITUATION FOR WOMEN, WHY
WOULD TWO-THIRDS OF THE STUDIES
AND TESTING BE FOCUSED ON MEN?

The caption changes to “Paula Harvey. Women’s College Hospital.”

Paula says THAT'S ACTUALLY A SIGNIFICANT
IMPROVEMENT FROM TWO DECADES AGO
WHEN I STARTED IN THE AREA OF
WOMEN'S CARDIOVASCULAR DISEASE.
ONE OF THE MAJOR ISSUES WHEN
YOU'RE DOING RESEARCH, WHETHER
YOU'RE DOING RESEARCH IN ANIMALS
OR RESEARCH IN HUMANS IS THAT
FIRST YOU HAVE TO IDENTIFY THAT
THERE'S A PROBLEM.
SO WE NEEDED TO IDENTIFY WOMEN
ACTUALLY HAD HEART ATTACKS AND
HEART DISEASE, AND NOT JUST MEN.
SECONDLY, DOING TESTS IN WOMEN,
IN HUMAN SUBJECTS, CAN BE
COMPLICATED BECAUSE OF A NUMBER
OF FACTORS.
FIRSTLY, WOMEN ARE AT RISK OF
GETTING PREGNANT AND THERE ARE
CONCERNS ABOUT THE SAFETY OF THE
WOMAN AND THE FOETUS IF YOU HAVE
SOMEBODY IN A CLINICAL TRIAL AND
THAT'S MADE PEOPLE VERY WARY
ABOUT INCLUDING WOMEN INTO
CLINICAL TRIALS.

Steve says THAT TAKES A WHOLE
BUNCH OF PEOPLE OUT OF THE MIX
RIGHT AWAY.

Paula says RIGHT.
AND THE FUNDING BODIES ARE
ACTUALLY ADDRESSING THAT AND
MAKING SURE THAT WOMEN CAN BE
SAFELY INCLUDED IN CLINICAL
TRIALS IN THEIR REPRODUCTIVE
YEARS.
AND SECONDLY WOMEN HAVE THIS
COMPLICATION OF WHAT WE CALL SEX
HORMONES.
WE HAVE A REPRODUCTIVE LIFE SPAN
WHERE OUR BIOLOGY CHANGES IN
DIFFERENT PHASES OF LIFE,
THERE'S PREMENOPAUSE, THERE'S
POST MENOPAUSE, THERE'S
PREGNANCY, THERE'S POST
PREGNANCY.
THAT'S ANOTHER LAYER THAT NEEDS
TO BE INCLUDED IN THE CLINICAL
TRIALS.
SO EVEN IF YOU'RE DOING YOUR
STUDIES IN ANIMALS, IT MEANS YOU
HAVE TO TAKE INTO CONSIDERATION
THE BIOLOGICAL DIFFERENCES
BETWEEN MALE AND FEMALE ANIMALS.
SO TO INCORPORATE THE FEMALE
ANIMALS, WHICH ARE MORE COMPLEX
AND MORE DIFFICULT, YOU HAVE TO
BE AWARE AND THEN YOU HAVE TO
MAKE SURE THAT YOU HAVE THE
FUNDING AND YOU HAVE
DESIGNED YOUR TRIAL THAT WAY AND
YOU DO THE APPROPRIATE ANALYSIS.

Steve says BUT GIVEN THE WAY
YOU'VE DESCRIBED IT, SHOULD
WE -- IS IT TOO BIG A CHALLENGE
TO HOPE FOR THE DAY WHERE IT'S
MORE 50-50?

Paul says NO, I DON'T THINK SO.
I MEAN, I THINK THERE'S A HUGE
GROUNDSWELL.
THIS IS A GREAT TIME FOR US TO
BE TALKING ABOUT WOMEN AND HEART
DISEASE.
IT REALLY FITS IN VERY WELL WITH
AWARENESS ACROSS SOCIETY, NOT
JUST HEALTH CARE, ABOUT SEX,
GENDER, EQUITY.
AND THERE ARE STRATEGIES WHERE
THIS CAN BE INCORPORATED INTO
RESEARCH.
SO IF YOU'RE LOOKING AT SOME OF
THE FUNDING BODIES LIKEC.I.H.R.,
HEART AND STROKE --

Steve says CANADIAN --

Paula says SORRY.
YES, I SHOULDN'T -- FOR THE
ACRONYM.
IT'S ONE OF THE BIGGEST FUNDING
BODIES FOR HEALTH RESEARCH.
THEY REQUIRE, WHEN SOMEBODY PUTS
IN APP GRANT APPLICATION FOR A
RESEARCH STUDY, THAT THEY
INCORPORATE SEX AND GENDER INTO
THE STUDY PROTOCOL AND INTO THE
ANALYSIS, AND OTHER FUNDING
BODIES ARE FOLLOWING SUIT.

Steve says SHERRY, I THINK YOU
SAID IN THE HEART AND STROKE
REPORT THAT DOCTORS GENERALLY
DON'T REFER WOMEN TO REHAB AS
OFTEN AS MEN AFTER WOMEN HAVE A
HEART ATTACK.

Sherry says RIGHT.

Steve says WHY IS THAT?

The caption changes to “Sherry Grace. University Health Network.”

Sherry says YEAH, THIS IS VERY
INTERESTING.
REHAB PROGRAMS ARE KIND OF THESE
CHRONIC DISEASE MANAGEMENT
MODELS, SO PATIENTS AND WOMEN
COME IN AND SEE US A COUPLE OF
TIMES A WEEK OVER A FEW MONTHS,
AND, YEAH, WOMEN ARE LESS LIKELY
TO COME INTO OUR DOORS AND
THEY'RE LESS LIKELY TO STAY ONCE
WE DO GET THROUGH THE DOORS.
I THINK IT CAN BE -- AGAIN, IT'S
MULTIFACTORIAL, SO WE HAVE SHOWN
THERE'S BIAS ON THE PART OF
PROVIDERS, IT'S OFTEN
UNCONSCIOUS.
BUT WOMEN TOO MIGHT BE SAYING
THINGS TO THEIR PHYSICIANS LIKE
I CAN'T GET THERE BECAUSE I
DON'T HAVE TRANSPORTATION OR I
HAVE FAMILY CARE-GIVING
RESPONSIBILITIES, SO I CAN'T
MAKE IT THERE.
SO THERE'S KIND OF SOCIETAL AND
LOGISTIC FACTORS AS WELL AT
PLAY.

Steve says IS THAT WHY WOMEN
HAVE SECOND HEART ATTACKS,
BECAUSE THEY DON'T NECESSARILY
GET THE REHAB THEY NEED AFTER
THE FIRST?

Sherry says YES, EXACTLY.
WOMEN WHO HAVE HAD A HEART
ATTACK DEFINITELY SHOULD BE
COMING AND THOSE WHO DO COME TO
REHAB HAVE ABOUT 20 percent LOWER
CHANCES OF HAVING ANOTHER HEART
ATTACK, OF HAVING ANOTHER
HOSPITALIZATION, NEEDING A HEART
PROCEDURE, SO, EXACTLY.
IF WE DON'T GET THEM INTO THE
DOOR, WE'RE NOT GOING TO GET
THAT BENEFIT ACCRUE.

Steve says THIS ISSUE, THE
DIFFERENTIAL IN THE WAY MEN ARE
TESTED VERSUS WOMEN, DOES THIS
GO ACROSS SPECIALTIES OR IS IT
SPECIFIC TO THE HEART?

Paula says I WOULD -- I CAN'T SPEAK WITH
COMPLETE AUTHORITY, BUT I WOULD
SAY THAT THIS IS GOING TO BE
ACROSS.
BECAUSE OF THE COMPLEXITY OF
INCLUDING WOMEN IN YOUR RESEARCH
AND THE FEMALE VERSUS MALE
ANIMALS IN THE RESEARCH, I THINK
THIS IS ACTUALLY A PROBLEM
THAT'S COMMON TO ALL OF THE SUB
SPECIALTIES AND BELIEVE IT OR
NOT, CARDIOVASCULAR DISEASE IS
SOMEWHAT AHEAD OF THE GAME WHEN
IT COMES TO LOOKING AT SEX AND
GENDER DIFFERENCES.

Steve says SO MAYBE
TWO-THIRDS-ONE-THIRD, BUT IT'S
STILL BETTER THAN OTHERS.

Paula says IN SOME WAYS, YES.

Steve says THAIS, LET ME FOLLOW
UP ON ONE OF THE ANGLES.
HOW CAN PHYSICIANS CHECK THEIR
BIASES AT THE DOOR TO MAKE SURE
THEY ARE SERVING THEIR FEMALE
PATIENTS APPROPRIATELY?

Thais says IT'S A GREAT QUESTION.
FOR MANY ASPECTS OF HEALTH CARE,
ACTUALLY I WOULD ENCOURAGE
ANYBODY TO WATCHING TO TAKE
THEM.
EVEN THE ONES OF US WHO BELIEVE
THAT WE ARE VERY UNBIASED, WE
ACTUALLY LEARN THAT WE HAVE BIAS
EVEN IN SOME AREAS.
ONCE YOU'RE AWARE OF THAT BIAS,
YOU REFLECT ON THAT AND IT MAY
CHANGE THE WAY THAT YOU
PRACTICE.
THERE ARE TESTS PEOPLE CAN TAKE
TO REALIZE AND REFLECT UPON
THAT.

Steve says NOW, LET ME DRAW AN
INFERENCE HERE AND YOU TELL ME
IF IT'S CORRECT.
YOU'RE A FEMALE CARDIOLOGIST.
DOES THAT MEAN YOU ARE LESS
LIKELY TO HAVE A BIAS AGAINST
FEMALE PATIENTS AS OPPOSED TO A
MALE CARDIOLOGIST.

Thais says YOU'RE NOT ONLY TALKING TO A
FEMALE CARDIOLOGIST BUT A FEMALE
CARDIOLOGIST WHO RUNS A WOMEN'S
HEART HEALTH PROGRAM.
SO I'M VERY BIASED IN THE OTHER
DIRECTION, I THINK, ME AS A
PERSON, BECAUSE I'M SO
WELL-AWARE.
WE JUST RAN THIS NATIONAL SUMMIT
ABOUT WOMEN AND HEART DISEASE,
SO OF COURSE WE ARE PREACHING TO
THE CONVERTED HERE.
SO IN THAT SENSE I WOULD THINK
THAT MY BIAS FOR THE SPECIFIC
SUBJECT IS LOWER THAN USUAL.
IF YOU ACTUALLY LOOK ACROSS THE
COMMUNITY, THERE ARE STILL LOTS
OF FEMALE PROVIDERS WHO MAY HAVE
AN UNCONSCIOUS BIAS SIMPLY
BECAUSE WE ALL LEARN FROM THE
SAME BOOKS, RIGHT?
WE ALL LEARN FROM HEART DISEASE
LOOKS LIKE FROM THE SAME BOOKS
AND FROM SIMILAR MENTORS.
THE BIASES STILL EXIST IN MEN
AND WOMEN.

Steve says INTERESTING.
LET'S TAKE THAIS OUT OF THE
QUESTION BECAUSE WE KNOW HER
MISSION IN LIFE IS TO TURN THE
BIAS IN THE OTHER DIRECTION.
IN YOUR STUDIES AND IN YOUR
EXPERIENCE, DOES THAT BIAS EXIST
MORE IN WOMEN THAN IT DOES IN
FEMALE CARDIOLOGISTS?

The caption changes to “Sherry Grace. York University.”

Sherry says IT DOES.
WE HAD A STUDY WHERE WE
PRESENTED PHYSICIANS IN ONTARIO
RURAL-URBAN PHYSICIANS, FAMILY
PHYSICIANS AND SPECIALISTS, WITH
DIFFERENT SCENARIOS AS A HEART
PATIENT.
AND WE KIND OF RANDOMLY BY THE
FLIP OF A COIN PRESENTED MEN
VERSUS WOMEN AND WE ASKED
PHYSICIANS, HOW LIKELY ARE YOU
TO REFER THIS PATIENT, HOW HOW
MUCH DO YOU THINK YOU'LL BENEFIT
FROM THEM?
WE WERE ABLE TO SHOW THAT INDEED
THERE IS MUCH UNCONSCIOUS GENDER
BIAS STILL AND ALSO THAT ABOUT
TWO-THIRDS OF THE PHYSICIANS
WEREN'T AWARE THAT THEY WERE
BIASED.
STILL TO THIS DAY HERE IN
ONTARIO.

Steve says WHAT DO YOU WANT TO
DO ABOUT IT?

Sherry says AS THAIS MENTIONED THERE ARE
STRATEGIES AROUND EDUCATION TO
INCREASE AWARENESS AMONG HEALTH
CARE PROVIDERS.

Steve says IF YOU'RE IN MED
SCHOOL NOW, THAT WILL BE
HELPFUL.
WHAT ABOUT THE PEOPLE
PRACTISING --

Sherry says RIGHT.
WE NEED TO DO CONTINUING MEDICAL
EDUCATION, AND WE NEED TO
INCREASE AWARENESS BY DOING
SHOWS LIKE THIS TODAY.
AND WOMEN NEED TO KNOW, SAY YOU
HAVE A HEART PROBLEM AND YOU'RE
HAVING CHEST PAIN AND ALSO
HAVING SWEATING AND NAUSEA AND
INDIGESTION, WHEN YOU GET TO THE
EMERGENCY DEPARTMENT, SAY "I
HAVE CHEST PAIN" BECAUSE THEY
WILL INITIATE THE CHEST PAIN
PROTOCOL AROUND GETTING AN ECG
AND YOU GET TREATMENT QUICKLY
AND HAVE LESS HEART DAMAGE.
AGAIN, WOMEN ADVOCATING FOR
THEMSELVES AND BEING AWARE THAT
THEY NEED TO GO TO REHAB AND
WHAT TESTS AND TREATMENTS THEY
NEED.

Steve says GOTCHA.
THAIS, HOW DIFFERENT PHYSICALLY
IS THE FEMALE HEART FROM THE
MALE HEART?

The caption changes to “Caring for women’s hearts. The heart of the matter.”

The caption changes to “Thais Coutinho. @ThaisCoutinhoMD.”

The caption changes to “Connect with us: tvo.org, @theagenda, Facebook, YouTube, Periscope and Instagram.”

Thais says FROM A VERY SIMPLE
PERSPECTIVE, YOU KNOW, FEMALE
HEARTS ARE SMALLER, THE ARTERIES
ARE SMALLER.
WE ARE SMALLER PEOPLE IN GENERAL
COMPARED TO MEN.
BUT OUTSIDE OF THIS GROSS
ANATOMICAL DIFFERENCES THERE ARE
ACTUALLY MANY THINGS THAT ARE
VERY SIMILAR BETWEEN THE TWO
PEOPLE.
I THINK WHAT DIFFERS IS BEYOND
JUST THE VISUAL INSPECTION,
SOMETIMES THE TYPES OF DISEASE
THAT ONE HEART MAY BE MORE
PREDISPOSED TO THAN THE OTHER,
FOR EXAMPLE, OR THE WAY IN WHICH
WOMEN PERCEIVE THE SYMPTOMS,
PERCEIVE THE SIGNS OF HEART
DISEASE COMPARED TO A MAN.
SO THERE ARE SOME ANATOMICAL
DIFFERENCES, BUT EVEN BEYOND
THAT, A LOT OF DIFFERENCES
BETWEEN DISEASE PREDISPOSITION
AND INTERPRETATION OF DISEASE
SIGNS AND SYMPTOMS.

Steve says PAULA, LET ME FOLLOW
UP WITH THIS: THE SORT OF
TYPICAL IMAGE WE HAVE IN OUR
MIND OF SOMEBODY HAVING A HEART
ATTACK, SOMEBODY WHO FEELS THAT
PAIN GOING UP THE LEFT ARM,
GRABS THEIR CHEST AND MAYBE
COLLAPSES, WHEN WE THINK OF THAT
IT'S ALMOST ALWAYS A MAN WE
THINK OF DOING THAT.
DO WOMEN EXPERIENCE IT THE SAME
WAY?

Paula says THAT'S WHAT WE CALL THE
HOLLYWOOD HEART ATTACK.

Steve says BECAUSE IT REALLY
DOESN'T HAPPEN THAT WAY?

Paula says NO, IT DOES.
BUT ONE OF THE THINGS THAT THAIS
WAS JUST TOUCHING ON THERE IS
THAT THE STUDIES HAVE SHOWN THAT
WOMEN AND MEN DO PRESENT WITH
CHEST DISCOMFORT.
BUT MEN ARE MORE LIKELY TO CALL
IT PAIN.
AND WOMEN HAVE A DIFFERENT WAY
OF DESCRIBING THEIR SYMPTOMS.
SO IT MAY BE WHERE A MAN SAYS
HE'S GOT TERRIBLE PAIN, A WOMEN
MAY SAY SHE'S GOT PRESSURE.
OR SOME SORT OF SQUEEZING OR A
KNIFE-LIKE PAIN IN HER CHEST.
SO IT'S DIFFERENT IN THE WAY
THAT THEY PRESENT, AND THEN THEY
ARE PROBABLY MORE LIKELY TO HAVE
THESE OTHER SYMPTOMS LIKE
SWEATING AND NAUSEA AND FEELING
LIKE THEY'RE GOING TO PASS OUT.
SO PART OF IT IS THE WAY THAT
WOMEN PRESENT, AND WE USED TO
REFER TO WOMEN AS HAVING
ATYPICAL SYMPTOMS BECAUSE THEY
DIDN'T HAVE THE HOLLYWOOD HEART
ATTACK.
BUT IF 50 percent OF THE POPULATION IS
WOMEN, WHY WOULD THAT BE
ATYPICAL?
SO WHAT WE'RE ACTUALLY REFERRING
TO NOW IS FEMALE PATTERN OF
SYMPTOMS AND FEMALE PATTERNS OF
CHEST PAIN, RATHER THAN ATYPICAL
SYMPTOMS.

Steve says DOES THAT INCLUDE
THE PAIN IN THE LEFT ARM?

Paula says IT CAN INCLUDE PAIN IN THE
LEFT ARM AND INCLUDE PAIN IN THE
JAW.

Steve says IN THE JAW?

Paula says ANYTHING UP TO THE EAR LOBES
IS FAIR GAME FOR PAIN FROM THE
HEART.

Steve says FORGIVE ME.
UMBILICUS?

Paula says THE BELLY BUTTON.

Steve says THE UMBILICAL CORD?

Paula says YES.
FROM THE MIDDLE OF YOUR WAIST TO
YOUR EARS, YOU CAN EXPERIENCE
DISCOMFORT IN RELATION TO A
HEART ATTACK.

Steve says SHERRY, WHY IS IT
THAT THE SORT OF BEST WELL-KNOWN
SYMPTOMS SEEM TO RELATE TO MEN
AS OPPOSED TO WOMEN?

The caption changes to “Sherry Grace. @sherrylgrace.”

Sherry says YEAH.
I THINK, AS WE'VE ALLUDED TO,
THAT IT'S TYPICALLY BEEN THOUGHT
OF AS A MAN'S DISEASE AND WE
THOUGHT MORE MEN HAD HEART
DISEASE THAN WOMEN, BUT IT'S NOT
THE CASE.
THERE ARE AN EQUAL NUMBER OF
CASES IN CANADA AS HEART DISEASE
IN WOMEN AND MEN.
DESPITE A FUNCTION OF RAW
NUMBERS, WE NEED TO RECOGNIZE
THAT WOMEN AND MEN ARE BOTH
LIKELY TO HAVE HEART DISEASE.

Steve says I GUESS WHAT I'M
FISHING FOR HERE IS WHETHER MEN
TEND TO BE THE STORYTELLERS OF
HEART DISEASE AND THEREFORE,
WHEN WE THINK HEART DISEASE, WE
THINK MEN, THEREBY IGNORING HALF
THE POPULATION.

Sherry says RIGHT.
AND I THINK WOMEN OFTEN THINK
BREAST CANCER.
THEY ARE FIVE TIMES MORE LIKELY
TO DIE OF HEART DISEASE THAN
BREAST CANCER, BUT THEY WILL BE
CONCERNED ABOUT GETTING, YOU
KNOW, BREAST SCREENING AND IT'S
JUST A SHAME BECAUSE WE KNOW
THAT THEY'RE MUCH MORE LIKELY TO
DIE OF HEART DISEASE.

Steve says IN WHICH CASE WE
BETTER LEAVE ADVICE FOR PEOPLE
THIS MORNING -- EXCUSE ME, THIS
EVENING.
THAIS, I WANT TO GET YOU IN HERE
FIRST.
WHAT CAN WOMEN DO TO PREVENT
HEART HEALTH DISEASE?

The caption changes to “Caring for women’s hearts. An ounce of prevention.”

The caption changes to “For more information: yourheart.ca.”

Thais says IT'S A GREAT QUESTION BECAUSE
WE KNOW THAT 80 percent OF
CARDIOVASCULAR DISEASE CAN BE
PREVENTED AND THAT GOES FOR MEN
AND WOMEN.
SO THE ADVICE I WOULD GIVE TO
WOMEN THAT ARE WATCHING IS,
FIRST OF ALL, IF YOU'VE NEVER
HAD HEART DISEASE, JUST KNOW
WHAT THE RISK FACTORS ARE AND
KNOW WHAT YOUR INDIVIDUAL RISK
IS.
SO THE WAY TO DO THAT IS YOU CAN
GO TO RELIABLE WEB SITES, I'LL
GIVE AN EXAMPLE, IF YOU GO TO
YOURHEALTH.CA AND YOU CAN LINK
TO OUR LIBRARY AND ALSO TO OUR
VIRTUAL CARE PROGRAM AND HAVE
THAT ASSESSMENT YOURSELF, OR YOU
CAN TALK TO YOUR FAMILY DOCTOR,
YOUR CARDIOLOGIST, AND GET YOUR
RISK FACTOR ASSESSMENT.
KNOW WHAT YOUR RISK IS.
BECAUSE THE EXAMPLE I LIKE TO
GIVE IS, IF I'M DRIVING A CAR
AND I DON'T EVEN KNOW THAT
GETTING INTO A CAR CRASH IS A
POSSIBILITY FOR ME, I'M NOT
GOING TO BUCKLE MY SEAT BELT,
RIGHT?
THAT'S WHY WE SAY A WOMAN HAS TO
KNOW, AM I AT RISK AND WHAT ARE
MY RISK FACTORS SO THEY CAN WORK
WITH THEIR PROVIDERS TO REALLY
ENHANCE THEIR CARDIOVASCULAR
RISK FACTORS AND REALLY PREVENT
DISEASE.
WE ACTUALLY GOT A VERY GOOD
METHOD FROM A KEYNOTE SPEAKER
FOR OUR SUMMIT THIS PAST WEEK,
AND SHE TOLD US IF A PERSON, MAN
OR WOMAN, HAS NO CARDIOVASCULAR
RISK FACTORS BEFORE THE AGE OF
50, THE RISK OF THEM HAVING
CARDIOVASCULAR DISEASE IN THEIR
LIFETIME FROM THAT POINT ON IS
ONLY 5 percent.
SO, YOU KNOW, IT'S A GOOD METHOD
HERE FOR PREVENTION.
FOR WOMEN WHO ARE OUT THERE WHO
HAVE ALREADY HAD HEART DISEASE,
IT'S VERY IMPORTANT THAT THEY
TAKE OWNERSHIP OF THEIR HEALTH,
AND NOT ONLY DO THEY MONITOR
THEIR RISK FACTORS GOING
FORWARD, OF COURSE TO PREVENT
ADDITIONAL EVENTS IN SITUATIONS
WHERE IT CAN BE PREVENTED, BUT
ALSO TO KNOW WHAT CAUSES IT,
WHAT ARE SYMPTOMS, HOW TO
ADVOCATE FOR YOUR OWN HEALTH,
YOU KNOW, REALLY TAKE OWNERSHIP
AND PUT THEMSELVES FIRST.
AS WOMEN, WE ARE VERY GOOD AT
PUTTING EVERYBODY ELSE AHEAD OF
US, BUT IN SITUATIONS LIKE THIS,
IT'S SO IMPORTANT TO TAKE CARE
OF OUR HEARTS.
WE HAVE TO REMIND WOMEN TO
ALWAYS PUT THEMSELVES FIRST WHEN
IT COMES TO THEIR OWN HEALTH.

Sherry says AND I WOULD MAYBE ADD, STEVE,
AS WELL, THAT THERE ARE CERTAIN
RISK FACTORS THAT ARE ACTUALLY
MORE HAZARDOUS IN WOMEN THAN MEN
IF THEY HAVE THEM.
FOR EXAMPLE, SMOKING.
IF YOU HAVE TEN MEN AND WOMEN
THAT SMOKE, MORE WOMEN WILL
DEVELOP HEART DISEASE THAN MEN.
SAME AS WITH BLOOD SUGARS,
DIABETES.
AND DEPRESSION.
IT'S AN UNDERVALUED OR
UNDERKNOWN OR AWARE SYMPTOMS OF
HEART DISEASE.
WOMEN HAVE TWO TIMES THE RATES
OF MENTAL HEALTH ISSUES SUCH AS
DEPRESSION AND ANXIETY AS MEN
AND IT'S INDICATED IN BOTH THE
DEVELOPMENT OF HEART DISEASE AND
ALSO PROGNOSIS.

Steve says AT WHAT AGE, PAULA,
ARE YOU MOST VULNERABLE AS A
WOMAN TO SUFFER A HEART ATTACK
OR DEALING WITH HEART DISEASE?

Paula says THERE'S SORT OF TWO TIMES IN
OUR LIFE WHEN WE'RE PARTICULARLY
AT RISK.
SO TO BEGIN WITH WE KNOW THAT
OLDER WOMEN ARE AT RISK OF HEART
DISEASE -- ACTUALLY THEY'RE --

Steve says DEFINE OLDER.

Paula says SOMEONE WHO IS POST
MENOPAUSAL.
AND USUALLY THE WOMAN IN THE
SECOND PART OF HER LIFE IS
LIKELY TO DEVELOP HEART DISEASE
TEN YEARS LATER THAN A MAN, AND
THAT'S PROBLEMATIC.
BECAUSE OFTEN THEY HAVE OTHER
CONDITIONS AS WELL.
WHAT WE CALL COMORBIDITIES.
THE SECOND HALF OF OUR LIFE
PARTICULARLY OLDER, OVER 60, 65.
AND THEN THERE'S THE -- IN THE
PREMENOPAUSAL PHASE, WE HAVE TO
REMEMBER THAT PREGNANCY IS LIKE
A STRESS TEST, AND WOMEN GOING
THROUGH A PREGNANCY, THEY ARE AT
INCREASED RISK OF THINGS LIKE
PREGNANCY INDUCED HYPERTENSION
AND DIABETES AND
PREGNANCY-RELATED COMPLICATIONS
AT THE TIME.
WE KNOW IF THEY DEVELOP THOSE
PROBLEMS IN PREGNANCY, THEY'RE
TWO TIMES AS LIKELY TO DEVELOP
HEART DISEASE IN LATER LIFE, SO
WE NEED TO BE AWARE OF WHAT'S
HAPPENING --

Steve says LET ME UNDERSTAND
THAT.
CAN PREGNANCY CREATE NEW
UNDERLYING ISSUES LEADING TO
HEART DISEASE?

Paula says THERE ARE OTHER NOT RELATED
TO THE SORT OF HEART ATTACKS
WE'RE TALKING ABOUT, THAT
THEY'RE PREGNANCY-SPECIFIC
ISSUES AND THAT CAN AFFECT THE
HEART BUT ALSO THE EFFECTS ON
BLOOD SUGAR AND HIGH BLOOD
PRESSURE WHICH REALLY WE ARE
LEARNING A LOT NOW THAT THERE
ARE SPECIFIC RISK FACTORS FOR
HEART DISEASE IN WOMEN GOING
FORWARD, AND WOMEN NEED TO
UNDERSTAND THAT AND THEIR HEALTH
CARE PROVIDERS NEED TO
UNDERSTAND THAT.

Steve says WE HAVE A LITTLE
MORE THAN A MINUTE LEFT TO GO,
SHERRY.
I HAVE TO CONFESS.
I KNOW LOTS OF MEN WHO HAVE HAD
HEART BYPASS SURGERY.
I DON'T THINK I KNOW ANY WOMEN
THAT HAVE HAD IT.
IS THAT TYPICAL?

Sherry says THEY'RE LESS LIKELY TO BE
TREATED AGGRESSIVELY, THEY'RE
LESS LIKELY TO BE TREATED BY A
SPECIALIST, THEY'RE LESS LIKELY
TO GET THE MEDICATIONS AND THE
PROCEDURES ARE LESS AGGRESSIVE
AND THEY HAVE POORER OUTCOMES.
WE KNOW HOW TO TREAT WOMEN
SPECIFICALLY AND WHAT THESE
TREATMENTS, HOW THEY IMPACT
WOMEN DIFFERENTLY THAN MEN
THROUGH OUR RESEARCH STUDIES.

Steve says AND IS THAT
HAPPENING?

Sherry says IT IS.
IT IS NOW HAPPENING IN CANADA
AND I THINK WE'RE DOING ACTUALLY
A REALLY NICE JOB AND LEADING
GLOBALLY.

Steve says WHEN WE HAVE THIS
CONVERSATION AGAIN IN TEN YEARS,
YOU'RE GOING TO BE ABLE TO SAY
THINGS ARE SO MUCH BETTER NOW
THAT WE'RE SO MUCH MORE AWARE.

Sherry says YES, AND WE'RE SAVING SO MANY
MORE WOMEN'S LIVES.

Steve says OK GOOD TO KNOW.
THAT'S OUR TIME,
EVERYBODY.
THANK YOU SO MUCH FOR THIS.
ABSOLUTELY REVEALING.
THAIS COUTINHO, CARDIOLOGIST
UNIVERSITY OF
OTTAWA'S HEART INSTITUTE.
SHERRY GRACE, UNIVERSITY HEALTH
NETWORK AND YORK UNIVERSITY.
PAULA HARVEY, PHYSICIAN IN
CHIEF, DEPARTMENT OF MEDICINE,
WOMEN'S COLLEGE HOSPITAL.
GREAT TO HAVE YOU ALL ON TVO
TONIGHT.
THANK YOU VERY MUCH.

They all say THANKS STEVE

The caption changes to “Caring for women’s hearts. Producer: Cara Stern. @carastern. Student intern: Sarah Bhola.”

Watch: Caring for a Woman's Heart