Societal and Medical Bias elevates risk of Cardiovascular Disease in Urban Women

Cardiovascular diseases (CVD), most often considered a "man's disease" are conditions that affect the heart or blood vessel. Although age-standardized incidents of CVD are higher in males than females, a study found that there is no such difference in the prevalence of CVD (3%) among men and women in Bangladesh.

Besides, a number of clinical studies have shown that women have a higher mortality rate along with a poorer prognosis following an acute cardiovascular (CV) event despite having a lower incidence rate of these conditions compared to men.

However, there are disparities in care for women in our social context where their caregiver role jeopardizes their ability to receive timely diagnosis and treatment, which disproportionately impacts poor, rural women.

The risk of cardiovascular disease in women is frequently underestimated due to the misconception that women are better 'protected' against CVD than men.

Reportedly, women receive fewer diagnostic angiograms and interventional procedures than men. It is observed that female patients are misdiagnosed due to their symptoms being more unusual than that of the standard ones, which are the CVD symptoms of males.

Due to the negligence in the medical community to study female subjects, there is a huge gap in understanding the different symptoms a female patient shows due to her difference in biology. The risk factors for CVDs can be broken down into two categories: general risk factors and factors that are unique to women. Regarding the common risk factors, people's age, hypertension, total cholesterol, and low-density lipoprotein (LDL)-cholesterol all have a significant impact on their risk. On the other hand, women are more likely to be affected by smoking, diabetes, elevated triglyceride, and high-density lipoprotein (HDL) cholesterol levels.

When it comes to conditions that are unique to women, polycystic ovary syndrome (PCOS), menopause, pregnancy-induced hypertension (PIH), preeclampsia, and gestational diabetes mellitus (GDM) all have a significant impact on the cardiovascular system. Following a study, many women said that their doctors never discuss coronary risk with them and occasionally fail to notice the symptoms, mistaking them for signs of panic disorder, stress, etc.

Moreover, no substantial data has been gathered by the medical community to understand the prevalence and nature of female CVD patients in the country. The majority of the focus in terms of female health is on their reproductive health and cancer in the medical research and policy development area.

Another significant problem is the underrepresentation of women in medical trials and studies. Women are often excluded from clinical trials, and the results of these trials are applied to both men and women. This can result in women receiving inadequate treatment because the way in which they respond to medication may differ from that of men. For instance, research has shown that aspirin is significantly more effective at preventing heart attacks in men than it is in women.

Nevertheless, the biggest risk factor for increased risk of CVDs among women is the societal norms and position of a woman. The society of Bangladesh is patriarchal, and inequality between the genders is deeply ingrained in the culture of the country.

This inequality can be seen in virtually every facet of life, including the healthcare that is provided. Women are frequently subjected to discrimination in the medical field, and their requirements are frequently disregarded. This prejudice is present from the moment a person is born.

In Bangladesh, the infant mortality rate for girls under the age of five is higher than the rate for boys, as reported by UNICEF. This prejudice follows them throughout their entire lives, which is detrimental to their health.

Due to the patriarchal nature of society, financial state, and misconceptions, the men in the family get priority for health checkups and treatment. The financial situation of middle and lower-income families also subjects the female members' health to negligence. In addition to that, women from middle and low economic setting are usually put their needs at the very last, which is true for their health also; as they tend to hide their illness for as long as they can.^vii As a result, the CVDs symptoms are ignored in the case of women until it's too severe. O

n the other hand, unique to women risk factors such as pregnancy-related complications and menopause increase the risk of CVDs in women compared to their male counterparts. Moreover, the modern lifestyle has put immense stress on a woman, be it from carrying out traditional household duties with less or no support, taking care of children, to contributing to the overall economy of household alongside to their regular tasks. This constant struggle between family and career is causing more stress in women.

According to the World Heart Federation, one in every three death of females is due to CVDs. ^xii It is high time for the societies and especially the medical communities to take proper action to understand the gravity of the situation. In this regard, intense research on the matter should be a top priority along with increased health literacy among the mass regarding CVDs in women.