December 12, 2005
Investigators from the University of Michigan say that women with heart disease tend to minimize their symptoms far more than men. Their findings, based on a survey conducted in 348 men and 142 women with coronary artery disease, are reported in the November, 2005 issue of the American Journal of Medicine.
All patients surveyed had been admitted to the hospital with chest pain due to coronary artery disease between 1999 and 2002. The survey asked several questions to help the investigators assess the actual severity of the patients' heart disease, and also included a question regarding how severe each patient considered their symptoms to be: very mild, mild, moderate, severe or very severe.
On average, the women had significantly more cardiac-related physical limitations than the men - as measured by their capacity for daily activities, and their general physical and mental health status. Yet, even though women were "sicker" than the men, more of them rated their heart disease as very mild or mild than did the men. Also, the men were much more likely to perceive their heart disease as severe than the women. The investigators believe that the discrepancy between the severity levels reported by men and women was not due to the men over-exaggerating their illness (they felt that the men accurately described their cardiac limitations,) but instead was due to the women minimizing their symptoms.
DrRich comments:
We can only speculate why women might tend to minimize their cardiac symptoms (and, one suspects, their symptoms with any chronic illness.) DrRich suspects there may be at least two reasons First, many women, once they reach middle age, feel (and indeed are) primarily responsible for the well-being of several generations within their families. Perhaps these women just can't afford to admit to any significant physical limitations, and so they simply "tough it out." Second, women's' expectations for how well they ought to feel as they get older might be different from men's, and perhaps more realistic; men might be more likely to expect to feel 25 until the day they die - and when they don't, they complain.
Whether or not either of these speculations are correct, the fact that women tend to minimize their cardiac symptoms is of more than just passing interest. For, to the extent that our society is operating under a system of covert health care rationing, unless patients complain of symptoms these days (and complain vociferously,) it is relatively unlikely that doctors will go out of their way to look for problems (or prescribe expensive diagnostic procedures or treatments.) Thus, women's relative silence regarding their cardiac symptoms may explain at least some of the famous discrepancy that exists within the health care system, wherein women fail to receive the same level of cardiac services as men, and possibly as a result have worse clinical outcomes.
So women: If you have heart disease you should expect, like men, to feel good. And if you don't, then let your doctor know about it. Often there's something that can be done to significantly improve your symptoms - and even your survival - as long as your doctor's attention is focused appropriately.
