Every 22 minutes, a woman in Canada dies of a heart attack.
But the majority don’t have to, experts say, warning that more women will die unnecessarily if the medical community doesn’t tailor care to their needs.
“We have one of the best health-care systems in the world, and we’re not serving women,” said Dr. Paula Harvey, a cardiologist and head of the department of medicine at Women’s College Hospital in Toronto. “We have to do better.”
Heart disease is a top killer of women in Canada, and the push to change that is more urgent than ever. Harvey says more younger women are presenting with classic high risk factors for heart disease: high blood pressure, diabetes and obesity.
“There’s this trend to cardiovascular risk factors starting to be a problem at an earlier age, and I find that disturbing,” said Harvey. “I never used to see a woman in her 40s with high blood pressure. I’m starting to see that, and that’s going to mean that we’ll have more premature heart disease.”
How hormone levels affect heart health
Some studies have already found the heart attack rate among women aged 35-54 has gone up.
Lifestyle factors play a role in the trend, but the threat itself is broader — the majority of Canadian women have at least one risk factor for cardiovascular disease. Women with diabetes and those who come from certain racial or ethnic backgrounds are at higher risk, but fluctuating hormones can wreak havoc with any woman’s heart health, especially as they enter menopause and levels of the heart-protecting hormone, estrogen, start to drop.
That transition starts when women are in their 40s and can catch many off guard, Harvey said.
“I do think that a lot of that comes from the fact that women are still not being educated, they’re not being counselled, they don’t understand the impact of our changing biology with age that puts them at cardiovascular risk.”
Heart disease kills 5 times more women than breast cancer
According to the Canadian Women’s Heart Health Centre, at the University of Ottawa Heart Institute, 24,000 Canadian women die of heart disease every year. That’s nearly five times more deaths than from breast cancer.
Yet when it comes to heart health, experts say it’s still largely a man’s world: Women remain underdiagnosed, undertreated and unaware.
“It is a glass ceiling. It’s a glass ceiling for awareness, it’s a glass ceiling for research and for how we provide care,” said Karin Humphries, an associate professor at the University of British Columbia whose has researched gender and sex differences in the diagnosis, treatment and outcomes of patients with cardiovascular disease.
The basic medical model is still male-dominated and contributes to a general lack of awareness among women and health-care providers, Humphries said. And while awareness is growing, it’s not growing fast enough, she said.
“Everything in our culture emphasizes that cardiovascular disease is a man’s disease. I mean, think of Hollywood. Every time you see a heart attack, it’s on the male, right? You’re not watching a woman in a Hollywood movie having a heart attack.”
Heart attack symptoms more subtle in women
Part of the problem is that women’s symptoms can be different than those of men and can be attributed by both doctors and women themselves to stress and busy lives. For example, months before a heart attack, women may experience unusual fatigue, trouble sleeping, indigestion and anxiety.
Even during a heart attack, the symptoms can be subtle. Women are more likely to have chest discomfort, shortness of breath and even neck, jaw or back pain.
“I was still, you know, two months after my event, still reeling from that shock,” said Risa Mallory, who had a heart attack four years ago at age 61.
Mallory had been experiencing discomfort in her chest for several days, she said, but it came and went and didn’t seem so bad — until it suddenly was.
“On the fourth day, I experienced chest pain. It had changed. It was much more severe. I was feeling nauseous and I had this sense of fight or flight,” she recalled. “I remember sitting in the car, rocking, and saying, ‘We gotta go, we gotta go, we gotta go.'”
Mallory ended up in the emergency room and got help in time. But it was a close call. Heart disease runs in her family, she was aware of her own risk, but she still almost missed the warning signs.
That’s something that happens often, according to a 2018 Heart and Stroke Foundation report. The report found that early signs of a heart attack were missed in 78 per cent of women.
“What it tells us is that there are still a lot of inequalities and biases at the community level and the health-care provider level,” said Dr. Thais Coutinho, a cardiologist and chair of the Canadian Women’s Heart Health Centre at the University of Ottawa Heart Institute.
Many women are in the dark, Coutinho said, in large part because much of the medical community is too.
Most cardiac research done with male patients
Even now, the majority of heart disease research is conducted on men — despite important physiological differences, she said. Women’s hearts and arteries are smaller, and plaque builds in different ways. Standard diagnostic tests like angiograms and stress tests are often not sensitive enough to detect heart disease in women.
“That assumption still permeates through the cardiovascular research community that women are small men,” Coutinho said. “I do a lot of sex- and gender-based research, or women-specific cardiovascular research, and it’s amazing the differences that you find if you look. All of the gaps that we know exist from awareness, diagnosis, treatment, care, rehabilitation, education, everything — it starts with knowledge.
“So if we don’t even know what the differences are, we don’t know how to manage them.”
‘There’s something wrong with my heart’
Samia Janna was 48 when she first went to her doctor in 2018 because of shortness of breath. The Ottawa-area woman was prescribed anti-anxiety medication and told to take it easy. But the symptoms persisted.
Janna went back to her doctor twice more, only to be given the same advice.
“At that time, I said, ‘No, I know it’s not anxiety,'” Janna says. “I know myself. There’s something wrong with my heart.”
Blood tests didn’t flag anything, but Janna insisted on an ultrasound to check her heart. It revealed Janna’s heart was enlarged and causing damage to her heart valves. She ended up having two open heart surgeries.
Janna says it was hard to let go of her anger about the fact that her concerns were initially dismissed. She joined a cardiac rehabilitation program and says it helped her regain her physical and emotional strength. “If it wasn’t for them. I would have been in a different place now, in a very dark place.”
Female patients less likely to get cardiac rehab
Research finds women are up to 50 per cent less likely than men to attend cardiac rehab programs, often because they don’t get referred to one or face other barriers to follow-up care, including a tendency to minimize their own needs.
It helps explain why women who have a heart attack are more likely to die or experience a second heart attack compared to men.
Harvey says research is beginning to uncover the biological, medical, and social reasons for this — and the hope is that new knowledge will lead to advances in tailoring prevention and treatment to women’s needs.
But she points out, 80 per cent of heart attacks can be prevented and women can decrease major risk factors by managing high blood pressure, not smoking and sticking to a healthy weight. Harvey says women should also urge their doctors to check their hearts.
“We need to be empowered,” she says. “Knowledge is power. Advocacy is power. And do what you can so that you are aware of cardiovascular risk.”
And though prevention is key, Humphries says women should not hesitate to get help if they feel something is wrong.
“Call 911 and ask for help. Don’t worry about, you know, taking up time for health-care providers. They’re there to help you. And if you find out there’s nothing wrong with you, that’s wonderful. But absolutely do not hesitate and call 911.”
Secrets of 'SuperAgers' who possess brains as sharp as people 20 to 30 years younger – CNN
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Despite volunteering and working out at the gym several days each week, socializing frequently with friends and family, reading all manner of books and doing daily crossword puzzles, 85-year-old Carol Siegler is restless.
“I’m bored. I feel like a Corvette being used as a grocery cart,” said Siegler, who lives in the Chicago suburb of Palatine.
Siegler is a cognitive “SuperAger,” possessing a brain as sharp as people 20 to 30 years younger. She is part of an elite group enrolled in the Northwestern SuperAging Research Program, which has been studying the elderly with superior memories for 14 years. The program is part of the Mesulam Center for Cognitive Neurology and Alzheimer’s Disease at Northwestern University Feinberg School of Medicine in Chicago.
“I’ve auditioned twice for ‘Jeopardy!’ and did well enough on it to be invited to the live auditions. Then Covid hit,” said Siegler.
“Who knows how well I would have done,” she added with a chuckle. “What I have told my children and anybody else who asked me: ‘I may know an awful lot about Beethoven and Liszt, but I know very little about Beyoncé and Lizzo.’”
What is a SuperAger?
To be a SuperAger, a term coined by the Northwestern researchers, a person must be over 80 and undergo extensive cognitive testing. Acceptance in the study only occurs if the person’s memory is as good or better than cognitively normal people in their 50s and 60s.
“SuperAgers are required to have outstanding episodic memory — the ability to recall everyday events and past personal experiences — but then SuperAgers just need to have at least average performance on the other cognitive tests,” said cognitive neuroscientist Emily Rogalski, a professor of psychiatry and behavioral sciences at Feinberg School of Medicine.
Only about 10% of people who apply to the program meet those criteria, said Rogalski, who developed the SuperAger project.
“It’s important to point out when we compare the SuperAgers to the average agers, they have similar levels of IQ, so the differences we’re seeing are not just due to intelligence,” she said.
Once accepted, colorful 3D scans are taken of the brain and cognitive testing and brain scans are repeated every year or so. Analysis of the data over the years have yielded fascinating results.
Bigger, tau-free neurons
Most people’s brains shrink as they grow older. In SuperAgers, however, studies have shown the cortex, responsible for thinking, decision-making and memory, remains much thicker and shrinks more slowly than those of people in their 50s and 60s.
A SuperAger’s brain, usually donated to the research program by participants after death, also has bigger, healthier cells in the entorhinal cortex. It’s “one of the first areas of the brain to get ‘hit’ by Alzheimer’s disease,” said Tamar Gefen, an assistant professor of psychiatry and behavioral sciences at Northwestern, in an email.
The entorhinal cortex has direct connections to another key memory center, the hippocampus, and “is essential for memory and learning,” said Gefen, the lead author of a November study comparing the brains of deceased SuperAgers with those of older and younger cognitively normal people and people diagnosed with early Alzheimer’s.
SuperAger brains had three times fewer tau tangles, or abnormal formations of protein within nerve cells, than the brains of cognitively healthy controls, the study also found. Tau tangles are a hallmark sign of Alzheimer’s and other dementias.
“We believe that larger neurons in the entorhinal cortex suggest that they are more ‘structurally sound’ and can perhaps withstand neurofibrillary tau tangle formation,” Gefen said.
Gefen also found the brains of SuperAgers had many more von economo neurons, a rare type of brain cell, which so far has been found in humans, great apes, elephants, whales, dolphins and songbirds. The corkscrew-like von economo neurons are thought to allow rapid communication across the brain. Another theory is that the neurons give humans and great apes an intuitive advantage in social situations.
The von economo neurons were found in the anterior cingulate cortex, which forms a collar in the front of the brain linking the cognitive, reasoning side with the emotional, feeling side. The anterior cingulate is thought to be important for regulating emotions and paying attention — another key to good memory.
Taken together, these discoveries appear to point to a genetic link to becoming a SuperAger, Gefen said. However, she added: “The only way to confirm whether SuperAgers are born with larger entorhinal neurons would be to measure these neurons from birth until death. That obviously isn’t possible.”
Can environment play a role?
SuperAgers share similar traits, said Rogalski, who is also the associate director of the Mesulam Center for Cognitive Neurology and Alzheimer Disease at Feinberg. These folks stay active physically. They tend to be positive. They challenge their brain every day, reading or learning something new — many continue to work into their 80s. SuperAgers are also social butterflies, surrounded by family and friends, and can often be found volunteering in the community.
“When we compare SuperAgers to normal agers we see that they tend to endorse more positive relations with others,” Rogalski said.
“This social connectedness may be a feature of SuperAgers that distinguishes them from those who are still doing well but who are what we would call an average or normal ager,” she said.
Looking back at her life, Carol Siegler recognizes many SuperAger traits. As a young child during the Great Depression, she taught herself to spell and play piano. She learned to read Hebrew at her grandfather’s knee, poring over his weekly Yiddish newspaper.
“I have a great memory. I’ve always had it,” Siegler said. “I was always the kid that you could say, ‘Hey, what’s Sofia’s phone number?’ and I would just know it off the top of my head.”
She graduated from high school at 16 and immediately went to college. Siegler got her pilot’s license at age 23 and later started a family business in her basement that grew to have 100 employees. At 82, she won the American Crossword Puzzle Tournament for her age group, which she said she entered “as a gag.”
After seeing an advertisement for the SuperAger program on television, Siegler thought it too sounded like fun. Being chosen as a SuperAger was a thrill, Siegler said, but she is aware she was born lucky.
“Somebody with the same abilities or talents as a SuperAger who lived in a place where there was very little way to express them, might never know that he or she had them,” she said. “And that is a true shame.”
Doctors urge parents to get routine vaccines for kids following pandemic disruptions – CP24
Preventable diseases like measles could follow trends seen elsewhere in the world and spread quickly in Canada due to a drop in routine vaccinations during the COVID-19 pandemic, say pediatricians who are urging parents to ensure their kids are fully immunized.
Provinces and territories log data on vaccinations provided in the community against infectious diseases like measles, diphtheria, polio and whooping cough, as well as vaccines against other illnesses administered in school immunization clinics.
Although much current data doesn’t cover years beyond 2019, provinces with more recent figures are already seeing a dramatic decline in routine vaccinations.
Pediatricians are concerned about possible outbreaks of preventable diseases if too many children were underimmunized or not vaccinated at all while public health clinics focused on COVID-19 vaccines. Widespread school closures and vaccine disinformation that swayed some parents against immunization efforts complicated matters still further.
Recent data from Public Health Ontario shows that for 12-year-olds, vaccination against the liver infection hepatitis B plummeted to about 17 per cent in the 2020 to 2021 school year, compared with 67 per cent in the school year ending in 2019.
For human papillomavirus, or HPV, which can cause cancer, the vaccination numbers were even lower, plunging to 0.8 per cent last year, compared with 58 per cent in 2019. For the meningococcal vaccine, which helps protect against four types of the bacteria that cause a rare disease, vaccinations fell to about 17 per cent from 80 per cent over the same time. Risks of the potentially deadly illness include meningitis, an infection of the lining of the brain and spinal cord.
“The large decline in coverage in 2019-20 and 2020-21 illustrates the impact of the COVID-19 pandemic, as there was limited capacity to deliver school-based immunization programs,” Public Health Ontario said in a statement.
It said data for uptake of vaccines aimed at protecting younger kids against measles, for example, is not available beyond 2019, and a report on later numbers is expected to be released next spring.
Dr. Monika Naus, medical director of Immunization Programs and Vaccine Preventable Diseases Service at the BC Centre for Disease Control, said in-school vaccines, starting in Grade 6, were delayed, but work is underway to return to pre-pandemic levels.
Younger children missed appointments at doctors’ offices while physicians were seeing patients virtually and public health clinics, which mostly administer routine vaccines for kids outside of the Lower Mainland region of the province, were busy with COVID-19 shots, Naus said.
Dr. Sam Wong, director of medical affairs for the Canadian Paediatric Society, said disinformation and vaccine hesitancy during the pandemic, “combined with the failure of the public health system” to provide routine vaccines, mean certain populations could be left vulnerable to highly contagious diseases like measles, which spreads through coughing and sneezing.
“You could walk into a room an hour after someone’s been in there and potentially get infected,” he said.
“We’re worried, as a group of health-care providers, that if you have lower rates of vaccinations that you’re more likely to have localized outbreaks of vaccine-preventable illnesses such as measles or mumps and chickenpox,” Wong said.
Wong said it’s important for doctors and parents to discuss the importance of routine vaccinations that have been proven effective for decades, adding some people believe young kids’ immune systems are not ready so they’d rather wait until they’re older.
“But that’s why you want to give the vaccine, because their immune system is not able to fight off infections,” he said.
“Some parents don’t want to even have discussions with me about it. But if there is an opening, I’m happy to talk about it,” said Wong, who works in Yellowknife, Edmonton and Victoria.
The Public Health Agency of Canada said Canadian studies have found immunization coverage declined during the pandemic for the measles, mumps and rubella vaccine.
Quebec saw a 39 per cent drop in April 2020 compared with 2019, the agency said, with the greatest impact seen in children aged 18 months.
In Alberta, the agency said vaccination for those diseases declined by 10 per cent in April 2020 compared with the same month a year earlier. Coverage for Ontario children under two decreased by 1.7 per cent, it added.
“The Public Health Agency of Canada continues to work with provinces and territories on an ongoing basis to understand the impact of the pandemic on routine immunization coverage across Canada, and to improve the availability of high-quality data to inform immunization programs,” it said in a statement.
It is currently in discussions with all jurisdictions on ways to monitor coverage of vaccines, similar to a surveillance system used for COVID-19 vaccines, the agency said.
Nova Scotia Health said its last report on childhood vaccines was completed three years ago, and numbers have fallen during the pandemic.
“Anecdotally, we know there was a drop in childhood vaccination, but we do not have the specific numbers available at this time,” it said in a statement.
However, the school immunization program is aiming to help students catch up on vaccines that were missed early in the pandemic, mostly through doctors’ offices, it said, adding that getting an appointment was a challenge for some families.
“We know that a substantial number of Nova Scotians do not have a family doctor. Public Health often works with local primary care clinics to provide vaccines to those who do not have a family doctor and some public health offices will offer clinics to this population.”
Last week, the World Health Organization and the United States Centers for Disease Control and Prevention released a statement saying a record high of nearly 40 million children missed first and second doses of the measles vaccine in 2021 due to disruptions in immunization programs since the start of the pandemic.
The two groups said there were an estimated nine million measles cases and 128,000 related deaths worldwide in 2021, and 22 countries experienced large outbreaks.
Dr. Noni MacDonald, a professor of pediatrics and infectious diseases at Dalhousie University in Halifax, said a national registry that could quickly tell doctors which children have not been vaccinated is essential in Canada.
“I feel like I’m banging my head against a brick wall,” she said of her efforts to call for that change.
“How can we do proper health-care planning when we don’t have the data?”
Canada is an “outlier” that lags behind most European countries on the measles vaccine, she said, adding a coverage rate of 95 per cent is needed to create so-called herd immunity against the highly infectious disease.
Canada recently had 84 per cent uptake of the second dose of the measles vaccine. MacDonald said Australia, in comparison, had 94 per cent based on the most recent data from the WHO. She used the two countries as an example because they had a similar number of births — 368,000 in Canada, and 300,000 in Australia in 2021.
“We are just not in the same league, and we should be embarrassed.”
This report by The Canadian Press was first published Nov. 27, 2022.
This story was produced with financial assistance from the Canadian Medical Association.
Cobourg resident first at Peterborough Regional Health Centre to receive new cancer treatment
Two years ago, a doctor looked at a CT scan of Stuart Morley’s kidney and saw a tumour. It was small — only 15 millimetres — but the Cobourg resident was over 80 years old, so major surgery wasn’t the best option for him. Instead, he was a candidate for a minimally invasive interventional radiology procedure.
Stuart became the first-ever patient at Peterborough Regional Health Centre (PRHC) to receive life-changing cancer treatment by interventional radiology-radiofrequency ablation.
The amateur photographer and retired radiographer tells how PRHC’s Dr. Kebby King put a metal probe through a small cut in his skin and, using a CT to guide her, found the tumour and dissolved it with radio waves.
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“It was amazing,” Stuart recalls. “I felt no pain and I was able to go home later that afternoon. Now I’m back taking photos and looking forward to travelling the world again. I worked in diagnostic imaging for 12 years. But back in the ’60s, we could never have imagined the kinds of things doctors can do these days.”
Interventional radiology is often described as ‘the future of medicine’. It’s used to diagnose and treat a wide range of emergency and chronic health conditions such as cancer and other illnesses, without the use of conventional surgery and the associated pain, complications, and longer hospital stays.
For patients in the Peterborough region, this means they can go home sooner, with less pain and less risk, all without having to travel far away.
VIDEO: Interventional Radiology is helping to revolutionize cancer care at PRHC
Interventional radiologist Dr. King describes that difference as “night and day.”
It’s remarkable how many life-threatening health conditions can be diagnosed and treated with this innovative specialty. It can be used to biopsy or treat tumours like Stuart’s, put in ports for chemotherapy, or stop bleeding — in as little as an hour.
Dr. King and her colleagues already perform 6,000 interventional radiology procedures each year at PRHC, and the need for this kind of care is only growing in our region. PRHC’s interventional radiology suites are 14 years old, however, and are too small to fit new advanced technology and the staff required to use it.
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A $6 million investment in state-of-the-art equipment, upgraded suites, and an expanded recovery room is essential to meeting the need — so more patients with more complex conditions can be diagnosed and treated close to home.
Grateful for the great care he received and determined to help pave the way for new ground-breaking therapies to be offered at PRHC in the near future, Stuart donated to the PRHC Foundation for the first time. He wants to support the interventional radiology renovation and upgrade, and he knows that the government doesn’t fund hospital equipment.
“Our regional hospital needs our help,” Stuart says. “I’m asking everyone to join me in donating to support the interventional radiology facilities. Pictures can save lives. I know this because medical imaging saved mine. Now, our donations will help others. Thank you for helping to give people like me a brighter future.”
Not only do donations fund state-of-the-art technology not funded by the government, fuel innovation, and bring new services to our region, they also help PRHC attract and retain the best and brightest healthcare professionals. Doctors, nurses and staff want to do their jobs to the best of their abilities, and advanced equipment and innovative treatments support them in doing that.
This holiday season, donors and grateful patients like Stuart can help ensure PRHC’s frontline workers have the tools they need to provide expert, compassionate care, and receive some good cheer. Tribute donations can include a message of thanks or best wishes to a hospital department or individual physician, nurse or staff member when made online at prhcfoundation.ca or by phone at 705-876-5000.
To donate, find out more about interventional radiology, or share your own PRHC grateful patient story, please visit prhcfoundation.ca or call 705-876-5000.
This branded editorial was published in partnership with the PRHC Foundation. If your organization or business is interested in a branded editorial, contact us.
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