Disease-Mongering Du Jour: Heart Disease in Young Women. Red Competing with Pink?

Editor’s Note: The following guest post by Gary Schwitzer is reprinted with permission from his HealthNewsReview blog, an indispensable resource for tracking the best and worst of healthcare journalism.

Disease-mongering du jour: heart disease in young women. Red competing with pink?

by Gary Schwitzer

Go Red for Women.jpgAlmost as if the American Heart Association felt it must compete for some of the pinkwashing attention given breast cancer in October, it presents its “Go Red for Women” campaign with the message, “Make it your mission to fight heart disease in women.”

As with so many disease awareness campaigns, this is, at its conceptual core, a noble goal.

But as with so many disease awareness campaigns, it is the framing of the message that can be problematic.

AHA features a video of actress Elizabeth Banks – who some online sources say is 37 years old in real life – having a heart attack. Many TV viewers may associate her most recently as being of childbearing age after her pregnant portrayal on NBC’s “30 Rock.”


Why would the American Heart Association choose to profile such a young actress in its featured video?

We went to the Risk Assessment Tool for Estimating 10-year Risk of Developing Hard CHD (Myocardial Infarction and Coronary Death) of the National Cholesterol Education Program of the National Heart, Lung and Blood Institute. We entered the following data points for Ms. Banks’ character in the video. (Let’s not quibble about the numbers we pulled out of thin air. The video gave us no details about the hypothetical character it chose to feature. If anything, we chose some risk numbers that were worse than what would be supported by anything in the video.)

Age: 37
Total cholesterdol 250 mg/dL
HDL cholesterol: 25 mg/dL
Systolic blood pressure: 170 (unmedicated)

So what is this hypothetical character’s 10 year risk of having a heart attack?


Should the American Heart Association choose to feature – for all women to see – someone who – at worst – has a 2% risk over the next 10 years of having a heart attack?

We could debate that for a long time. But we think it’s disease-mongering. They could have made the point every bit as effectively by featuring a more representative/realistic demographic in an equally appealing and humorous leading lady.

Heart disease in women is a very important problem – one that often doesn’t receive enough attention. But why not give it proper attention? Not presenting an unrepresentative risk profile as the featured case study in a featured video.

Note that the department store Macy’s and the drugmaker Merck are key sponsors of the campaign. Both would love to reach a younger female demographic with their “Go Red” (see green $$$) support of this campaign. Macy’s would love the shoppers. Merck would love the heart drug business.

There seems to be no end to the disease awareness disease-mongering.


  1. Matthew Bannister says

    Larry: thanks for reposting this.

    Couple of points:

    – the numbers that Gary used were completely fabricated. How can he draw a conclusion that she is at low risk? Hypertension is called the silent killer — could Elizabeth not have high cholesterol or high blood pressure and not be aware of it? One of the main challenges we face is women are not aware they are at risk.
    – how about family history? Elizabeth’s mother and her sister both had arrhythmias, her dad had heart disease. You can see her discuss this in the companion behind the scenes video, also available on YouTube. YouTube.com/officialgored4women#p/a/u/2/OdkGd-TgRKo
    – this film debuted on September 13, almost one month ago. It is not a reaction to ‘pinkwashing’, it is an effort to call attention to the Number One killer of women…especially those who may not be aware they are at risk.

    Our purpose is to get women to make it their mission to be aware of their risk and fight heart disease…which, as you know, kills more women than all forms of cancer combined.

    Thanks for helping us get this message out.

  2. Matthew, Thanks for your response. A few points in defense of Gary, with whom I largely agree on this issue.

    Although heart disease is indeed the #1 killer of women, it is almost certainly NOT the #1 killer of women of child-bearing age like Elizabeth Banks. In the absence of hypertension or diabetes, an otherwise healthy woman like Elizabeth Banks is extremely unlikely to have a heart attack.

    In targeting this population, wouldn’t it make much more sense to recommend risk factor screening and modification (where appropriate and indicated, of course) rather than instilling fear in the wrong population? Or, as Gary suggested, wouldn’t it be better to use an older actress who is closer in age to the women who actually get the most heart attacks?

    It’s easy to imagine young, healthy women, after seeing a video like this, returning from the gym after a hard workout and mistaking their sore muscles for a heart attack. That strikes me as a step backward rather than a step forward in women’s health.

    Like everyone else, young women need to know about the various risk factors for heart disease, but for the most part they can also take comfort in the thought that they have enough time to do something about their risk.

    Just one final note: I gotta admit it’s a terrific, funny video. It’s hard not to love Elizabeth Banks.

  3. Brian Choi says

    Heart disease in women is definitely underappreciated. Her 2% risk of a heart attack in the next 10 years is still >4x greater than the average risk of a 37-year old woman of having breast cancer in the next 5 (using the Gail model), but ask the average 37-year old what they think they are at higher risk for, I bet most would still answer breast cancer. I contend that the awareness gap is real and relevant.

  4. Carolyn Thomas says

    “It’s easy to imagine young, healthy women, after seeing a video like this, returning from the gym after a hard workout and mistaking their sore muscles for a heart attack.”

    You might think so, Larry, but here’s what actually is far more likely to happen: a woman dismisses her serious heart attack symptoms as just a sore muscle after a hard workout. Or indigestion. Or stress. She continues to ignore symptoms, at her peril. She goes about her business in deep denial. This is the tragically accurate reality, and one reason that women’s cardiac outcomes are far worse than their male counterparts. Convincing women to learn about and then SEEK HELP for heart attack symptoms is challenging, because most women still believe that:
    1. heart disease is a man’s problem
    2. “I’m too young to be having a heart attack!”

    And we’re not alone in believing these myths. The majority of physicians (as surveyed in a 2005 AHA study) were unaware that more women than men die of heart disease every year.

    Oregon researchers in fact have identified six distinct “treatment-seeking delay” behaviours unique to women in mid-heart attack. Cardiologists have long puzzled over this pervasive sense of denial in women, and their known reluctance/refusal to seek immediate help.

    The truth is that this brilliant little film does more in three minutes to educate us about commonly seen heart attack symptoms in women (of any age) than any other awareness campaign I’ve seen in the past three years since surviving my own heart attack.

    I didn’t interpret the purpose of this film, in three short minutes, to provide comprehensive details on cardiac risk factors. How could it? Nor did I get bogged down by the age of the main character, who in Gary’s dismissive opinion, is not “representative” of a “real” heart attack survivor). This is nit-picking of the highest order. What the film accomplishes, beautifully, is an entertaining and memorable lesson for all women (yes, including young women – a demographic in which heart disease rates are growing, not falling, particularly for young black women).

    And even if the AHA had chosen a more “representative” star (middle aged? smoking? fat?) more to Gary’s liking, he would still be accusing the campaign of disease mongering as he does in this unfortunate headline, since he implies that the film’s sinister commercial purpose is to get more women to go shopping at Macy’s (one of the Go Red For Women sponsors).

    To use the words “disease mongering” and “heart disease in young women” together in the same sentence is regrettable and ill-informed. I know what disease mongering is, and this film is not it.

    • Carolyn, I appreciate your thoughtful comment and I hope you won’t accuse me of “mansplaining” if I continue to disagree with you here. Here’s how I view it:

      You are completely right that heart disease is a major problem for women, and that most women and healthcare professionals are not sufficiently aware of the magnitude of the problem. Every appropriate effort should be taken to remedy that problem.

      However, we don’t want to turn everyone into a patient, and we don’t want people to become obsessive and medicalize every aspect of their existence. There is life outside of medicine, after all, and if we’re healthy we should enjoy life, for the brief time we have it!

      There’s a million things that all of us can worry about. One thing that the vast majority of young women don’t need to worry about it is having a heart attack in the very near future (unless they’re taking cocaine or have other serious medical issues, of course). So I don’t see the value of adding this worry to all the other worries, at this stage.

      But it’s equally important that young women be educated about their future risk of CV disease, and about the host of behaviors and choices that they can take now to reduce that risk in the future. To my mind, focusing on the risk of a heart attack now actually distracts from this much more important goal, and substitutes fear for rational thought.

      • Carolyn Thomas says

        I think Brian Choi’s comment (above) deserves a re-read for an accurate perspective on just how much “heart disease is a major problem for women” – particularly for young women. But with all due respect, Larry, you may be in grave danger of missing the point here. When we’re talking about women’s cardiac events, we are talking about a gender with documented evidence of denying, dismissing and ignoring serious heart attack symptoms at the time they occur, and with potentially deadly results. ‘Time is muscle’, as cardiologists like to say.

        What does concern me (and what this film is entirely focused on) is what happens, or doesn’t happen, when women delay seeking treatment when serious heart attack symptoms hit. Middle-aged women frequently cannot believe that their most distressing cardiac symptoms are heart-related. For young women, it’s even more unbelievable, which is why they are NOT calling 911.

        And I too have written about the issues you are concerned about (for example, issues like “catastrophizing” and “disease-seeking vs health-seeking behaviours”). But these issues are far from the actual lived experience in women’s heart health. If only women were flocking to the E.R. to get distressing cardiac symptoms checked out! I wish! Just the opposite – it’s actually difficult to convince women to take their valid symptoms seriously enough to stop what they’re doing and seek help (as this film describes beautifully). More on the Oregon research that succinctly illustrates this problem at: http://myheartsisters.org/2009/05/22/know-and-go-during-heart-attack/

        Don’t take my word for this, Larry (I know you won’t!) You are already an eloquent voice on cardiac issues. Please check out resources like the Mayo Women’s Heart Clinic or WomenHeart: The National Coalition for Women With Heart Disease, or the outstanding new ‘Make the Call: Don’t Miss a Beat’ campaign – http://www.womenshealth.gov/heartattack/

        Or better yet, try sitting down with a real live 30/40-something young female heart attack survivor (some of whom have left convincing comments re Gary’s post on HNR or Forbes) for a real education on the value of a good heart attack awareness campaign.

  5. I cannot believe the condescension in the above posts. Are you aware that you basically said we shouldn’t scare the poor young things? And “if we’re healthy we should enjoy life, for the brief time we have it!”

    Well that’s a mighty big IF. And if you blink, you’ll be dead.

    As a former “poor young thing” who had a spontaneous coronary artery dissection at age 38, followed by heart attack and double bypass surgery, I assure you it would have done me a world of good to have an obstetrician, pediatrician, internist, or physician’s assistant who was just a little curious about my pre-heart attack symptoms in the weeks after my second child’s birth. Yes … I consulted all those professionals — and a lactation consultant — but received no help whatsoever.

    In fact, in the six days between the onset of my “classic men’s heart attack symptoms” and the day I finally had a cath, at least half dozen hospital physicians said there was “no way” it was my heart. I was a young thing, after all. Picture of health! Enjoying life!

    “Substituting fear for rational thought.” Let’s pretend: you are having a heart attack and no one believes you. For six days. I assure you, you will be afraid and no amount of well-meaning rational thought will convince you that the crushing pain you’re experiencing isn’t real.

    I could get all man-bashy and point out that a male patient would never have to wait for SIX days to have a heart catheterization. He would have had one the first ER visit. (Oops, sorry about that guys.)

    So please. Be a bit rational and consider the fact that the at-risk 2% quoted who are unworthy of attention could very well be your daughter, your niece, or your little sister. And remember: research statics don’t include the dead.

  6. Carolyn Thomas says

    Hi Larry – I’ve had a number of reports from women survivors who say CardioBrief is apparently not accepting comments here. Is that true?

  7. I approve all comments, as long as they’re not spam, personal attacks, or off topic. Once someone has had a comment approved new comments are automatically approved.

  8. Sharon Markey says

    As a Mom having had a heart attack and triple bypass at the age of 38, I would have benefited from that commercial. Not knowing risks, symptoms and stats almost killed me in March of 2006. Awareness for women and heart disease needs to start early. Being in phenomenal shape save my life and also gave me and a doctors I came into contact with a wake- up call. If that commercial saves one life then it was well worth it.

  9. I too took the same 10-year risk assessment tool the author references in his article. It calculated my risk of having a heart attack at 1%. Too bad I already had one. And I’m 37 and a marathon runner who doesn’t smoke and doesn’t have diabetes or high blood pressure.

    I find it troubling at best and insulting at worst that it is important or necessary to alert the public that somehow women are going to begin imagining heart attacks because they saw this video (if that is indeed the sole purpose of this article). What will happen and what should happen is that women, mothers, wives, and daughters like me will listen to their bodies and care for themselves before it is too late.

  10. Hi Larry,

    I wonder if you and Gary have seen the new AMI55 study, that details exactly how women under age 55 — the target group for this YouTube video — have worse outcomes than men of the same age, following a cardiac event:

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