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Women face ‘striking inequalities’ in NHS heart care, study shows
Women are less likely to get the treatment recommended in clinical guidelines if they have a heart attack or are diagnosed with heart failure
Women face stark inequalities in diagnosis and treatment of four of the most common heart conditions in the UK, new research has shown.
The study, published in The Lancet Regional Health – Europe, found that women are less likely than men to undergo coronary angiograms, a crucial procedure to look inside their heart’s arteries, after a heart attack, and are less likely to be prescribed preventative treatments for heart attacks.
The findings, led by the University of Leeds and funded by the British Heart Foundation, highlighted an estimated 500 potentially avoidable deaths in the UK each year among patients waiting for treatment for aortic stenosis, a narrowing of the heart’s aortic valve which restricts blood flow around the body.
The British Heart Foundation said the research paints a “concerning picture of unequal care”, reinforcing the need for all political parties to prioritise efforts to tackle cardiovascular disease and health inequalities.
Professor Chris P Gale, professor of cardiovascular medicine at the University of Leeds and honorary consultant cardiologist at Leeds Teaching Hospitals NHS Trust who led the study, said: “We need urgent action to revive heart care.
“The NHS is full of fantastic people who make truly monumental efforts every day to do the very best for their patients. Despite this, the NHS is creaking at the seams and we see this played out in cardiovascular care and outcomes.
“Past efforts to transform heart care and drive down waiting lists were hugely successful and we must build on the lessons from these to move forward.”
He added: “It’s clear that we’re not making the most of NHS data and we’re missing vital opportunities for this to inform policy and help target investment.
“We need a systematic approach to collect data and report on all aspects of treatment, care and outcomes. Only then will we be able to improve patient’s experiences and outcomes across the board.”
Researchers brought together evidence from studies published over the last 20 years that explored how a person’s age, sex, ethnicity and postcode are linked to the heart care they receive and their outcomes.
The team focused on heart attacks, heart failure, atrial fibrillation and aortic stenosis as these conditions lead to significant pressure on the NHS.
Prompt treatment is crucial after a diagnosis of severe aortic stenosis, as around 50 per cent of patients will die within two years of symptoms beginning.
The review showed that older people and women are less likely to receive the treatment recommended in clinical guidelines if they have a heart attack or are diagnosed with heart failure.
While the evidence for age, sex and geography was clear, the researchers said it is harder to draw conclusions about the experiences of patients of different ethnicities due to a lack of evidence.
However, from the studies available they concluded that disparities do exist. For example, there was evidence that black patients with atrial fibrillation, a common type of abnormal heart rhythm, are less likely to receive blood thinning treatment to prevent stroke than white patients.
Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation and consultant cardiologist, said: “These findings should sound the alarm bell for the state of heart care in the UK.
“This concerning review is further evidence that people’s experience of heart care was far from equal even before the pandemic began. The pandemic underlined and amplified existing health inequalities and we fear these are worse than ever now that we are firmly in the grip of a heart care crisis.”
She continued: “To stop this crisis in its tracks and address the unjust inequalities in heart care, we need bold action from the government. Protecting our hearts by tackling risk factors will help to prevent heart disease and strokes happening in the first place.
“Prioritising NHS heart care will allow people to get the help they need more quickly, preventing avoidable death and disability. And powering up research will unlock the treatments and cures of tomorrow to give more people hope for a bright and healthy future.”
Simultaneous exposure to toxic chemicals and climate-related heat may be worsening fertility harms across humans and wildlife, research suggests.
The review of scientific literature looks at how endocrine-disrupting chemicals, often found in plastic, together with climate-related effects such as heat stress, are each linked to lower fertility and fecundity, meaning the ability to reproduce, across species including humans, wildlife and invertebrates.
Though the reproductive harms of each issue in isolation are well studied, there is little research on what happens when living organisms are exposed to both.
“Together, the two issues are likely to pose a greater threat to fertility, and the additive effect is “alarming”, said Susanne Brander, a study lead author and courtesy faculty at Oregon State University.
“You’re not just getting exposed to one, but two, stressors at the same time that both may affect your fertility, and in turn the overall impact is going to be a bit worse,” Brander said.
The paper looked at 177 studies.
Shanna Swan, a co-author on the new paper, co-produced a 2017 study that found sperm levels among men in western countries had fallen by more than 50 per cent over four decades. Other research has suggested human fertility has been declining at a similar rate.
The University of Washington’s Institute for Health Metrics and Evaluation has previously said the world was approaching a “low-fertility future”, with more than three quarters of countries below replacement rate by 2050.
The new paper’s authors focused on the effects of endocrine-disrupting chemicals and substances, including microplastics, bisphenol, phthalates and PFAS.
These are thought to cause a range of serious reproductive problems, disrupt hormones and be a potential driver of falling fertility.
Brander said the harms linked to these chemicals are often similar across organisms, from invertebrates to humans.
Phthalates, for example, have been linked to altered sperm shape in invertebrates, spermatogenesis in rodents, meaning sperm production, and reduced sperm counts in humans.
PFAS are also thought to affect sperm quality, and both have been linked to hormone disruption.
The chemicals are widespread in consumer goods, so people are often regularly exposed.
Meanwhile, previous research has shown how rising temperatures, lower oxygen levels and heat stress, among other effects linked to climate change, may also worsen infertility.
Heat stress has been found to affect human hormones, and is linked to spermatogenesis in rodents and bulls.
Research shows temperature also plays a role in sex determination in fish, reptiles and amphibians.
The species has evolved to choose which sex it produces in part based on temperature, and the heating planet can “push it too far in one direction or the other, which overrides that evolutionary benefit”, Brander said.
Similarly, many endocrine disruptors may alter environmental sex determination.
The study set out some of the overlapping effects of chemical exposure and climate change across taxonomic groups, from invertebrates to humans.
In birds, for example, exposure to increased temperature, PFAS, organochlorines and pyrethroids may each individually cause abnormal sperm, increased fledgling mortality, abnormal testes and population decline.
“What happens if they’re exposed to more than one of those stressors at the same time? There has been little exploration of that question.
“Even if there have not been a lot of studies looking at these simultaneously, if you have two different factors that both cause the same adverse effect, then there’s a likelihood that they are going to be additive,” Brander said.
Katie Pelch, a senior scientist with the Natural Resources Defense Council nonprofit, who was not part of the study, said the authors had reviewed high-quality science.
She said she wanted to see more examples of the overlap in impacts, but agreed with the overall premise.
“It is likely [multiple stressors] would have an additive effect, at very least, even if they have different mechanisms of harm,” Pelch added.
The solution to the systemic problems would involve tackling climate change and reducing the use of toxic chemicals.
The study cites the global reduction in the use of DDT and PCBs achieved under the Stockholm Convention as an example of an effective measure, but Brander said much more is needed.
“There is enough evidence in both areas to act to reduce our impact on the planet,” she said.
Home blood pressure checks after hypertensive pregnancy could cut the risk of heart attack, stroke and potentially early death, research suggests.
Women who regularly monitored their blood pressure in the weeks after giving birth, and had doctors tailor their medication if needed, had better functioning arteries nine months later than those who received routine care.
When the medication was adjusted to account for blood pressure changes, the women ended up with less stiff arteries, an effect researchers estimated could reduce the future risk of heart attack or stroke by 10 per cent.
Paul Leeson, professor of cardiovascular medicine who led the study, said the findings suggested that the weeks after birth provided a “powerful and often overlooked opportunity” to protect women’s future health.
“By simply monitoring blood pressure at home, new mothers with hypertensive pregnancies can protect their bodies from future damage,” he said.
High blood pressure, in the form of gestational hypertension or pre-eclampsia, where there are signs of organ damage, affects 5 to 10 per cent of pregnant women.
The condition can damage the mother’s organs and endanger the baby’s life.
Beyond the immediate threat to mother and baby, hypertension in pregnancy can raise the risk of long-term problems, with women three times more likely to develop high blood pressure and twice as likely to have heart disease later in life.
The Oxford team recruited 220 women who developed hypertension in pregnancy. All were on blood pressure medication but were due to reduce their dosage and eventually stop taking the drugs.
In the study, 108 women had standard care in which their medication was reduced based on a few blood pressure checks in the eight weeks after giving birth.
The remaining 112 women used a monitor to check their blood pressure at home each day.
They entered the readings into an app shared with doctors who, if needed, changed their medication day to day, with the aim of giving them better control of their blood pressure.
The new approach led to much better control of the women’s blood pressure, and in tests six to nine months later the women had less stiff arteries.
Stiff arteries are less effective at expanding and contracting, which can drive high blood pressure and ultimately the formation of clots that can block blood vessels and cause heart attacks and strokes.
Trials are now under way to find effective ways of rolling out blood pressure monitoring to women after hypertensive pregnancies. One option is for specialist NHS clinics to deliver the care.
Dr Sonya Babu-Narayan, clinical director at the British Heart Foundation, which funded the work, said the results highlighted a crucial window after birth when paying close attention to blood pressure could help protect women’s heart health for years to come.
“We now look forward to seeing results from larger studies with longer follow-up to see how this might save women’s lives,” she said.
Weight loss jabs are being studied to see if they could help women with polycystic ovary syndrome (PCOS)
The condition, which affects up to one in ten women, changes how the ovaries work and is linked to infertility and weight gain.
Dr Shagaf Bakour has won a £60,000 NHS research grant through Sandwell and West Birmingham NHS Trust to look at whether drugs such as Mounjaro and Ozempic might help.
“The research could lead to earlier support, better long-term health, and more joined-up care for a condition that affects many women but is still often overlooked,” she said.
Women with PCOS have higher levels of male hormones and can suffer from irregular periods and symptoms such as excess body or facial hair, the NHS said.
Associated weight gain can also lead to an increased risk of diabetes and heart problems.
Bakour, a gynaecologist and director of medical education at Aston Medical School, will work with a team to evaluate the effect of the weight loss medicines on metabolic and reproductive outcomes.
The drugs mimic a hormone called GLP-1, which suppresses appetite.
Bakour, alongside Dr Hoda Harb, a consultant obstetrician and gynaecologist at the NHS trust, will review existing evidence on their use and assess how they help patients with PCOS.
“The aim is to give women with PCOS evidence-informed, clearer treatment options and more consistent care,” she said.
“The project hopes to show whether these medicines can improve both general health and fertility health, while also helping local services develop clearer care pathways.
Prof Elizabeth Hughes, director of research and development at the NHS trust, said the effects of PCOS, including infertility, were “very emotive subjects”.
“We should be doing all we can within research and development to advance healthcare for women and to better help future generations with this condition,” she added.
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