The real heart disease gender gap and the cardiologists that get it all wrong.

Image by Pexels from Pixabay

---

There would appear to be confusion among some cardiologists about the relative prevalence of malignant heart disease between men and women as evidenced by this exchange on twitter from pre-pandemic times.

The only trouble with the 2018 stats from the American Heart Association that are dutifully amplified by a professor of cardiology at a major academic hospital is that it is completely misleading. Anyone that has spent any time in hospitals on a cardiac care unit knows that the number of men in the hospital with bad hearts significantly outnumbers women. (You don’t even have to work on a cardiac floor in a hospital… just take a poll at the next family gathering of who’s having heart attacks)

The reason the AHA data that’s derived from the national CDC wonder database doesn’t square with reality is because the graph is looking at the total number of deaths by gender from year to year. Using data from the CDC that breaks down cardiac deaths by age bracket in the year 2000 (a year where there appears to be many more deaths in women than men per the AHA chart) paints a very different story.

While it is indeed true that more women than men died of cardiac disease in the year 2000, it is also the case that in the 35-64 age group, two times as many men died of heart disease as women.

It isn’t until we get to the over 75 group that the absolute number of women dying of heart disease starts to exceed the number of men dying, and even here, there are so many fewer men than women left at these ages that the rate of cardiac death is still higher in men than women.

A cardiologist that uses crude mortality statistics in this manner is either incompetent or deliberately peddling misinformation. Appropriately adjusting for age yields the following graph for cardiac mortality from 1999 - 2020 that show men winning the cardiac mortality prize by a very wide margin.

This does not mean heart disease in women should be ignored.  While the large portion of cardiac deaths occur in women in later years, cardiovascular disease remains an important contributor to female mortality even at younger ages. As noted in the chart and graph below from the CDC, cardiac disease is the second leading cause of death even among women aged 35-64, though again, at rates that are less than half their male counterparts.

To understand the problem with getting the relative prevalence of disease in a population this wrong is to imagine a bizarro world where medical professors embark on a breast cancer screening program mistakenly believing breast cancer is more prevalent in men than women.

The correct understanding of the relative prevalence of malignant cardiac disease in men and women should also put the appropriate slant on papers that purport to portray cardiology as systemically biased against women because men are generally probed with diagnostic testing for heart disease at higher rates than women.

If there are more men being sent for stress tests than women that would be completely appropriate because fathers, brothers and sons are dying at 2 to 3 times the rate of their female counterparts in the prime of their life.

A cardiologist who sends female patients for cardiac testing more often than their male counterparts is no bueno. The cost to men and women patients of this muddled approach would be to miss important heart disease in men, and to subject women to potentially invasive tests they may not need.

Despite the realities of heart disease on the ground, the overwhelming academic narrative fueled by dubious research that almost never studies outcomes that matter like death from cardiac disease, has led to a multitude of women’s heart institutes popping up at academic institutions that basically function as a gateway to irradiating women with one imaging test or another. The biggest beneficiary of all of this isn’t women, it’s hospital cardiac and radiology department bottom lines that use their monopoly power to happily collect astronomical payments from insurance companies.

Anyone who has followed the COVID wars and the unending stream of nonsense from academia shouldn’t be surprised that the same credentialed experts who think the SCIENCE unequivocally favors masking 2-year-olds are also wrong about a whole lot more than COVID.

At least we know who to ignore now.

Anish Koka is a cardiologist. Follow him on twitter @anish_koka