Lifestyle

Women are at a higher risk of dying from heart disease − in part because doctors don’t take major sex and gender differences into account

Heart disease impacts women differently than men due to genetic and gender biases in healthcare. Awareness and improved treatment approaches are essential for better outcomes.

Published

2 months ago

October 25, 2024

The Conversation

Heart disease — Rates of heart disease and cardiac events in women are often underestimated. eternalcreative/iStock via Getty Images

Amy Huebschmann, University of Colorado Anschutz Medical Campus and Judith Regensteiner, University of Colorado Anschutz Medical Campus

A simple difference in the genetic code – two X chromosomes versus one X chromosome and one Y chromosome – can lead to major differences in heart disease. It turns out that these genetic differences influence more than just sex organs and sex assigned at birth – they fundamentally alter the way cardiovascular disease develops and presents.

While sex influences the mechanisms behind how cardiovascular disease develops, gender plays a role in how healthcare providers recognize and manage it. Sex refers to biological characteristics such as genetics, hormones, anatomy and physiology, while gender refers to social, psychological, and cultural constructs. Women are more likely to die after a first heart attack or stroke than men. Women are also more likely to have additional or different heart attack symptoms that go beyond chest pain, such as nausea, jaw pain, dizziness and fatigue. It is often difficult to fully disentangle the influences of sex on cardiovascular disease outcomes versus the influences of gender.

While women who haven’t entered menopause have a lower risk of cardiovascular disease than men, their cardiovascular risk accelerates dramatically after menopause. In addition, if a woman has Type 2 diabetes, her risk of heart attack accelerates to be equivalent to that of men, even if the woman with diabetes has not yet gone through menopause. Further data is needed to better understand differences in cardiovascular disease risk among nonbinary and transgender patients.

Despite these differences, one key thing is the same: Heart attack, stroke and other forms of cardiovascular disease are the leading cause of death for all people, regardless of sex or gender.

We are researchers who study women’s health and the way cardiovascular disease develops and presents differently in women and men. Our work has identified a crucial need to update medical guidelines with more sex-specific approaches to diagnosis and treatment in order to improve health outcomes for all.

Gender differences in heart disease

The reasons behind sex and gender differences in cardiovascular disease are not completely known. Nor are the distinct biological effects of sex, such as hormonal and genetic factors, versus gender, such as social, cultural and psychological factors, clearly differentiated.

What researchers do know is that the accumulated evidence of what good heart care should look like for women compared with men has as many holes in it as Swiss cheese. Medical evidence for treating cardiovascular disease often comes from trials that excluded women, since women for the most part weren’t included in scientific research until the NIH Revitalization Act of 1993. For example, current guidelines to treat cardiovascular risk factors such as high blood pressure are based primarily on data from men. This is despite evidence that differences in the way that cardiovascular disease develops leads women to experience cardiovascular disease differently.

Clinician holding stethoscope against a patient's chest — Gender biases in health care influence the kind of tests and attention that women receive. FG Trade Latin/E+ via Getty Images

In addition to sex differences, implicit gender biases among providers and gendered social norms among patients lead clinicians to underestimate the risk of cardiac events in women compared with men. These biases play a role in why women are more likely than men to die from cardiac events. For example, for patients with symptoms that are borderline for cardiovascular disease, clinicians tend to be more aggressive in ordering artery imaging for men than for women. One study linked this tendency to order less aggressive tests for women partly to a gender bias that men are more open than women to taking risks.

In a study of about 3,000 patients with a recent heart attack, women were less likely than men to think that their heart attack symptoms were due to a heart condition. Additionally, most women do not know that cardiovascular disease is the No. 1 cause of death among women. Overall, women’s misperceptions of their own risk may hold them back from getting a doctor to check out possible symptoms of a heart attack or stroke.

These issues are further exacerbated for women of color. Lack of access to health care and additional challenges drive health disparities among underrepresented racial and ethnic minority populations.

Sex difference in heart disease

Cardiovascular disease physically looks different for women and men, specifically in the plaque buildup on artery walls that contributes to illness.

Women have fewer cholesterol crystals and fewer calcium deposits in their artery plaque than men do. Physiological differences in the smallest blood vessels feeding the heart also play a role in cardiovascular outcomes.

Women are more likely than men to have cardiovascular disease that presents as multiple narrowed arteries that are not fully “clogged,” resulting in chest pain because blood flow can’t ratchet up enough to meet higher oxygen demands with exercise, much like a low-flow showerhead. When chest pain presents in this way, doctors call this condition ischemia and no obstructive coronary arteries. In comparison, men are more likely to have a “clogged” artery in a concentrated area that can be opened up with a stent or with cardiac bypass surgery. Options for multiple narrowed arteries have lagged behind treatment options for typical “clogged” arteries, which puts women at a disadvantage.

In addition, in the early stages of a heart attack, the levels of blood markers that indicate damage to the heart are lower in women than in men. This can lead to more missed diagnoses of coronary artery disease in women compared with men.

The reasons for these differences are not fully clear. Some potential factors include differences in artery plaque composition that make men’s plaque more likely to rupture or burst and women’s plaque more likely to erode. Women also have lower heart mass and smaller arteries than men even after taking body size into consideration.

Reducing sex disparities

Too often, women with symptoms of cardiovascular disease are sent away from doctor’s offices because of gender biases that “women don’t get heart disease.”

Considering how symptoms of cardiovascular disease vary by sex and gender could help doctors better care for all patients.

One way that the rubber is meeting the road is with regard to better approaches to diagnosing heart attacks for women and men. Specifically, when diagnosing heart attacks, using sex-specific cutoffs for blood tests that measure heart damage – called high-sensitivity troponin tests – can improve their accuracy, decreasing missed diagnoses, or false negatives, in women while also decreasing overdiagnoses, or false positives, in men.

Our research laboratory’s leaders, collaborators and other internationally recognized research colleagues – some of whom partner with our Ludeman Family Center for Women’s Health Research on the University of Colorado Anschutz Medical Campus – will continue this important work to close this gap between the sexes in health care. Research in this field is critical to shine a light on ways clinicians can better address sex-specific symptoms and to bring forward more tailored treatments.

The Biden administration’s recent executive order to advance women’s health research is paving the way for research to go beyond just understanding what causes sex differences in cardiovascular disease. Developing and testing right-sized approaches to care for each patient can help achieve better health for all.

Amy Huebschmann, Professor of Medicine, University of Colorado Anschutz Medical Campus and Judith Regensteiner, Professor of Medicine, University of Colorado Anschutz Medical Campus

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Our Lifestyle section on STM Daily News is a hub of inspiration and practical information, offering a range of articles that touch on various aspects of daily life. From tips on family finances to guides for maintaining health and wellness, we strive to empower our readers with knowledge and resources to enhance their lifestyles. Whether you’re seeking outdoor activity ideas, fashion trends, or travel recommendations, our lifestyle section has got you covered. Visit us today at https://stmdailynews.com/category/lifestyle/ and embark on a journey of discovery and self-improvement.

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Food and Beverage

Cinnamon, spice and ‘everything nice’ – why lead-tainted cinnamon products have turned up on shelves, and what questions consumers should ask

A Consumer Reports investigation revealed alarming lead levels in ground cinnamon, prompting concerns over safety, especially for children and pregnant women.

Published

1 hour ago

December 22, 2024

The Conversation

It’s important to buy cinnamon from reputable dealers. Anjelika Gretskaia/Moment via Getty Images

Katarzyna Kordas, University at Buffalo

Spices bring up feelings of comfort, cultural belonging and holidays. They can make our homes smell amazing and our food taste delicious. They can satisfy our cravings, expand our culinary horizons and help us eat things that we might normally dislike. Spices have health-enhancing properties and, in medicine, have been used to heal people since the ancient times.

Recently, however, spices have been getting a bad rep.

In September 2024, Consumer Reports, a nonprofit organization created to inform consumers about products sold in the U.S., investigated more than three dozen ground cinnamon products and found that 1 in 3 contained lead levels above 1 part per million, enough to trigger a recall in New York, one U.S. state that has published guidelines for heavy metals in spices.

The Food and Drug Administration issued three alerts throughout 2024, warning consumers about lead in certain brands of cinnamon products. Such notices rightfully put consumers on alert and have people wondering if the spice products they buy are safe – or not. https://www.youtube.com/embed/QxAwznMht8M?wmode=transparent&start=0 A Consumer Reports investigation of more than three dozen ground cinnamon products found that 1 in 3 contain lead levels above 1 part per million.

As an environmental epidemiologist with training in nutritional sciences, I have investigated the relationship between nutritional status, diets and heavy metal exposures in children.

There are several things consumers should be thinking about when it comes to lead – and other heavy metals – in cinnamon.

Why is lead found in cinnamon?

Most people are familiar with cinnamon in two forms – sticks and ground spice. Both come from the dried inner bark of the cinnamon tree, which is harvested after a few years of cultivation. For the U.S. market, cinnamon is largely imported from Indonesia, Vietnam, Sri Lanka, India and China.

One way that lead could accumulate in cinnamon tree bark is when trees are cultivated in contaminated soil. Lead can also be introduced in cinnamon products during processing, such as grinding.

When ground cinnamon is prepared, some producers may add lead compounds intentionally to enhance the weight or color of the product and, thus, fetch a higher sale price. This is known as “food adulteration,” and products with known or suspected adulteration are refused entry into the U.S.

However, in the fall of 2023, approximately 600 cases of elevated blood lead levels in the U.S., defined as levels equal to or above 3.5 micrograms per deciliter – mostly among children – were linked to the consumption of certain brands of cinnamon apple sauce. The levels of lead in cinnamon used to manufacture those products ranged from 2,270 to 5,110 parts per million, indicating food adulteration. The manufacturing plant was investigated by the FDA.

Horizontal photo of cinnamon trees, with trunks in foreground. — Cinnamon trees in Zanzibar, Tanzania. Zanzibar is known the world over as the ‘spice islands.’ Dong Jianghui/Xinhua via Getty Images

More broadly, spices purchased from vendors in the U.S. have lower lead levels than those sold abroad.

There is some evidence that cinnamon sticks have lower lead levels than ground spice. Lead levels in ground cinnamon sold in the U.S. and analyzed by Consumer Reports ranged from 0.02 to 3.52 parts per million. These levels were at least 1,500 times lower than in the adulterated cinnamon.

There are no federal guidelines for lead or other heavy metals in spices. New York state has proposed even stricter guidelines than its current level of 1 part per million, which would allow the New York Department of Agriculture and Markets to remove products from commerce if lead levels exceed 0.21 parts per million.

What does it mean that ‘the dose makes the poison’?

The current FDA guideline on daily intake of lead from diets overall is to limit lead intake to 2.2 micrograms per day for children. For women of reproductive age, this value is 8.8 micrograms.

The lead dose we are exposed to from foods depends on the level of lead in the food and how much of that food we eat. Higher doses mean more potential harm. The frequency with which we consume foods – meaning daily versus occasionally – also matters.

For spices like cinnamon, the amount and frequency of consumption depends on cultural traditions and personal preference. For many, cinnamon is a seasonal spice; others use it year-round in savory dishes or sauces.

Cinnamon is beloved in baked goods. Take a cinnamon roll recipe calling for 1.5 tablespoons (slightly less than 12 grams) of the spice. If a recipe yields 12 rolls, each will have around 1 gram of cinnamon. In the Consumer Reports investigation, some cinnamon products were classified as “okay to use” or “best to use.”

The highest value of lead in cinnamon products in the “okay to use” category was 0.87 parts per million, and in the “best to use” category, it was 0.15 parts per million. A child would have to consume 2.5 or more rolls made with the “okay to use” cinnamon to exceed the FDA guideline on limiting lead intake from foods to 2.2 micrograms per day, assuming that no other food contained lead. To exceed this guideline with “best to use” cinnamon, a child would have to eat 15 or more rolls.

Stick cinnamon and cinnamon powder on rustic wooden table. — Research suggests that ground cinnamon contains higher lead levels than cinnamon sticks. Helen Camacaro/Moment via Getty Images

Can cinnamon contribute to elevated blood lead levels?

Because of lead’s effects on development in early life, the greatest concern is for exposure in young children and pregnant women. Lead is absorbed in the small intestine, where it can latch onto cellular receptors that evolved to carry iron and other metals.

The impact of a contaminated spice on a person’s blood lead level depends on the dose of exposure and the proportion of lead available for intestinal absorption. For several spices, the proportion of available lead was 49%, which means that about half of the lead that is ingested will be absorbed.

Lead absorption is higher after a fast of three hours or more, and skipping breakfast may contribute to higher blood lead levels in children.

People who have nutritional deficiencies, such as iron deficiency, also tend to absorb more lead and have higher blood lead levels. This is because our bodies compensate for the deficiency by producing more receptors to capture iron from foods. Lead takes advantage of the additional receptors to enter the body. Young children and pregnant women are at higher risk for developing iron deficiency, so there is good reason for vigilance about lead in the foods they consume.

Studies show that among children with lead poisoning in the U.S., contaminated spices were one of several sources of lead exposure. Studies that estimate blood lead levels from statistical models suggest that consuming 5 micrograms of lead or more from spices daily could substantially contribute to elevated blood lead levels.

For occasional or seasonal consumption, or lower levels of contamination, more research is needed to understand how lead in spices would affect lead levels in the blood.

For people who have other sources of lead in their homes, jobs or hobbies, additional lead from foods or spices may matter more because it adds to the cumulative dose from multiple exposure sources.

How to test for elevated blood lead levels

The Centers for Disease Control and Prevention recommends that children at risk for lead exposure get a blood lead test at 1 and 2 years of age. Older children can also get tested. Finger-prick screening tests are often available in pediatric offices, but results may need to be confirmed in venous blood if the screening result was elevated.

Adults in the U.S. are not routinely tested for lead exposure, but concerned couples who plan on having children should talk to their health care providers.

What to consider when using or buying cinnamon or other spices

If the product is on an FDA Alert or the Consumer Reports “don’t use” list, discard it.

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Family

Tips for a Safe and Festive Holiday Season

Published

2 days ago

December 20, 2024

Daily News Staff

(Family Features) As people prepare to gather with family and friends this holiday season, it’s important to think about health and safety.

“With the holidays just around the corner, now is the perfect time to think about how you can help protect yourself from serious illness from flu, COVID-19 and RSV – and support your loved ones in doing the same,” said Dr. Rachel Levine, assistant secretary for health at the U.S. Department of Health and Human Services (HHS). “Vaccination is an important step in having a happy and healthy celebration.”

While preparing for holiday festivities, keep these recommendations in mind to help protect yourself from severe flu, COVID-19 and RSV.

Flu: Flu season usually peaks during the winter months, so now is a great time to get the 2024-25 flu vaccine. It’s recommended for people 6 months and older to lower their risk of infection or serious illness from the flu. In fact, people who skipped their flu shot last year were twice as likely to need medical help for the flu. The best time to get vaccinated is at least a couple of weeks before a holiday gathering. But getting vaccinated later in the season can still help. Encourage your family and friends to get the flu vaccine, too. Together you can create safer holiday celebrations.

COVID-19: Getting vaccinated against COVID-19 is also important for everyone ages 6 months and older. The updated COVID-19 vaccines offer the best protection against serious illness from the virus, especially for those at higher risk. This includes people with certain health conditions or older adults, which may include parents, grandparents and great aunts or uncles. By getting vaccinated, people of all ages can lower their risk of getting severely sick. In fact, young adults are at higher risk of developing Long COVID than older adults. However, staying up to date on your COVID-19 vaccines lowers your risk of Long COVID, too.

RSV: RSV can be especially risky for older adults and babies. That’s why everyone 75 and older, people 60-74 with certain health conditions or who live in a nursing home and pregnant people should get the RSV vaccine. Pregnant people should get the RSV vaccine at 32-36 weeks of pregnancy to help protect their newborns from severe RSV during their first six months of life.

As you prepare for the holidays, remember that prevention is the best way to keep from getting seriously sick from flu, COVID-19 and RSV. By getting vaccinated now, you can enjoy the holiday season with greater confidence and less risk of missing time together. Being vaccinated helps keep your symptoms milder if you get infected after vaccination so you can do the things you want to do with less risk of spreading infection.

Talk with your doctor about which vaccines are right for you as well as for any loved ones you help care for. Visit cdc.gov/RiskLessDoMore for more information on vaccines, or visit vaccines.gov to get started.

The Effects of Flu, COVID-19 and RSV on Different Populations

People who are Black, Hispanic or who live in rural areas may be at higher risk of severe illness from flu, COVID-19 and RSV than others. Getting vaccinated is the best protection from getting seriously sick from these viruses. According to the Centers for Disease Control and Prevention (CDC):

Last flu season, Black adults were more than twice as likely as white adults to be hospitalized for flu.
Last flu season, Hispanic adults were more likely than white adults to be hospitalized for flu.
One in 3 adults living in rural areas have never been vaccinated against COVID-19. For people living in rural areas, health services may be far away. That can mean it takes some planning to get vaccinated. But being far from medical care also means it’s even more important to lower your risk of serious illness by getting vaccinated.

Photos courtesy of Shutterstock

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SOURCE:
United States Department of Health and Human Services

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Lifestyle

Why sending a belated gift is not as bad as you probably think − and late is better than never

Research shows that gift recipients are less concerned about timely delivery than givers believe. Sending a late gift is often perceived more favorably than not sending anything at all.

Published

4 days ago

December 18, 2024

The Conversation

gift — The thoughtfulness counts more than the timeliness. Maria Korneeva/Moment via GettyImages

Rebecca Walker Reczek, The Ohio State University; Cory Haltman, The Ohio State University, and Grant Donnelly, The Ohio State University

If finding the right present and making sure the recipient gets it on time leaves you feeling anxious, you’re not alone. More than half of Americans say that gift-giving stresses them out.

Concerns about on-time delivery are so common that people share holiday deadlines for each shipping service. And in the event that you can’t meet these deadlines, there are now handy etiquette guides offering advice for how to inform the recipient.

If you’ve sent late gifts thanks to shipping delays, depleted stocks or even good old-fashioned procrastination, our new research may offer some welcome news.

In a series of studies that will soon be published in the Journal of Consumer Psychology, we found that people overestimate the negative consequences of sending a late gift.

Trying to follow norms

Why do people tend to overestimate these consequences? Our findings indicate that when people give presents, they pay more attention to norms about gifting than the recipients do.

For example, other researchers have found that people tend to be reluctant to give used products as presents because there’s a norm that gifts should be new. In reality, though, many people are often open to receiving used stuff.

We found that this mismatch also applies to beliefs about the importance of timing. Many people worry that a late gift will signal that they don’t care about the recipient. They then fear their relationship will suffer.

In reality, though, these fears are largely unfounded. Gift recipients are much less worried about when the gift arrives.

Unfortunately, aside from causing unnecessary worry, being overly sensitive about giving a late present can also influence the gift you choose to buy.

A Postal Service worker places packages on a parcel sorting machine. — A U.S. Postal Service worker places packages on a parcel sorting machine on Dec. 12, 2022. Alejandra Villa Loarca/Newsday RM via Getty Images

Compensating for lateness

To test how lateness concerns affect gift choice, we conducted an online study before Mother’s Day in 2021. We had 201 adults participate in a raffle. They could choose to send their mother either a cheaper gift basket that would arrive in time for the occasion or a more expensive one that would arrive late.

Concerns about lateness led nearly 70% of the participants to choose the less expensive and more prompt option.

In another study, we conducted the same kind of raffle for Father’s Day and got similar results.

Aside from finding that people will choose inferior items to ensure speedier delivery, we also found that givers may feel that they can compensate for lateness with effort.

In another online study of 805 adults, we discovered that participants were less likely to expect a late delivery to damage a relationship if they signaled their care for the recipient in a different way. For example, they believed that putting an item together by hand, versus purchasing it preassembled, could compensate for a present being belated.

Better late than never?

If sending something late isn’t as bad as expected, you may wonder whether it’s OK to simply not send anything at all.

We’d caution against going that route.

In another online study of 903 participants, we found that recipients believed that not receiving anything at all was more likely to harm a relationship than receiving something as much as two months late.

That is, late is better than never as far as those receiving gifts are concerned.

You may want to keep that in mind, even if that new gaming console, action figure or virtual reality headset is sold out this holiday season. It could still be a welcome surprise if it arrives in January or February.

Rebecca Walker Reczek, Professor of Marketing, The Ohio State University; Cory Haltman, Ph.D. Candidate in Marketing, The Ohio State University, and Grant Donnelly, Assistant Professor of Marketing, The Ohio State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.