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No. 589:
Gender and Heart Attack

Today, heart trouble and gender -- a parable about experimental science. The University of Houston's College of Engineering presents this series about the machines that make our civilization run, and the people whose ingenuity created them.

I've just given up cream. As a boy in Minnesota, I loved the rich fatty clots of cream floating above unhomogenized milk in the old glass bottles. Now my wife reminds me that I've promised to outlive her. My love affair with cream must end. And, oh, how I love rich fatty food.

So she and I play the heart-attack game by traditional rules. We worry about the male and ignore the issue in the female. "Don't get between me and chocolate!" She glowers. We take it on faith that heart trouble is a male problem.

Doctors have recently faced the charge of sexism in their treatment of heart disease. They seem to go after it aggressively in men and ignore it in women. Are the charges warranted?

Before WW-I, heart attack was often undiagnosed. It easily passed as gastric trouble -- maybe indigestion. Doctors began serious treatment of heart trouble only after WW-II.

It was soon clear that women are far less prone to heart attack during their reproductive years. At the age of 40 a man is five times more liable to heart attack. But after women reach 67, heart disease becomes their greatest killer.

The problem is, statistics feed themselves in strange ways. If women's hormones protect them while they're young, they also lull doctors to sleep. Men get better preventive care than women just because they're at greater risk.

We know less about heart disease in women. Their symptoms develop differently. We haven't learned to spot trouble as quickly. The result? Women undergo a higher fraction of emergency treatments. Emergency treatment is always more dangerous.

The problem is so complex. Traditional male and female roles are changing. Are women coming under greater stress? Maybe, maybe not. More women are smoking. Male and female hormones are a big part of an equation we don't yet know how to write. We aren't sure that estrogen protects women before menopause. Maybe the changes that follow menopause do the harm. The fact we aren't sure has to reflect some level of gender bias.

It all says a lot about the supposed objectivity of science. It reminds us that we can never make measurements without carrying ourselves into our observations. The very things we observe determine what we're willing to see.

So my wife worries about my heart while I take hers for granted. I probably am at greater risk -- for the moment. But danger really is catching up with her, faster than medical science is.

I'm John Lienhard, at the University of Houston, where we're interested in the way inventive minds work.

(Theme music)

Altman, L.K., Men, Women and Heart Disease: More Than a Question of Sexism. The New York Times, Science, Tuesday, August 6, 1991, pp. B5 & B8.

Shortly after I aired this episode, a friend suffered a severe heart attack. She's an active woman -- a mathematics teacher -- 48 years old and outwardly in very good health. She didn't go straight to the hospital, but stopped by her family clinic for an EKG. When she got to the hospital, suffering from chest pain, radiating pain in her arms, and nausea, the doctor told her,

"It's a good thing you brought that EKG. I would've dismissed you as suffering a minor stomach problem. You don't fit the heart attack profile at all."

Then he hurriedly sent her off for a triple bypass operation.