Toronto-based study aims to bridge the knowledge gap in women’s cardiovascular health

The Current23:28Closing the research gap with heart disease in women

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For 58-year-old Ellen Valter, volunteering in a heart study at Toronto’s Mount Sinai Hospital is a way for her to contribute to science in an area that lacks comprehensive information for women.

“I have found that it’s difficult to find information about the health effects for women of my age and older in various afflictions that advancing years seem to bring with them,” she told The Current.

Cardiovascular diseases are the leading cause of death globally, affecting both men and women. However, women have historically been underrepresented in cardiovascular disease research, and experts say this knowledge gap puts women at risk.

“I thought up until recently … because men experience things like a heart attack a little bit earlier than women, there was initially a perception that heart disease was a man’s disease,” said Dr. Susanna Mak, a cardiologist and the study’s principal investigator.

This study seeks the involvement of post-menopausal women like Valter to bridge that knowledge gap in women’s cardiovascular health.

Mak said the study involved placing monitors throughout a patient’s blood vessel system to measure heart and lung pressure, as well as blood flow.

A heart rate monitor displays a heart rate.
A heart rate monitor displays a heart rate. (Trisha Estabrooks/CBC)

She said it is invasive, but for context, these measurements are also routinely taken in critically ill patients.

“A patient who might be waiting for a heart transplant will have some of these types of monitors,” she said. “So they’ll be living with these monitors for a few days at a time — and these are people with very fragile hearts and lungs, and they can actually tolerate these monitors with relatively minimal risk.”

“For healthy people who have pretty strong hearts and lungs, the monitors themselves are actually a very, very, very low risk.”

Different experiences

Mak’s research focuses on understanding “how the mechanics of the heart and the circulation work,” and how that’s affected by aging.

Additionally, she wants to understand whether heart complications are different for men and women.

“Post-menopausal women and men … experienced cardiovascular disease slightly differently,” she said. “So things like stroke and heart failure may be more common in women as they age versus men.”

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Although men and women experience cardiovascular disease in relatively equal numbers, there are some differences in the manifestations of the disease, especially in terms of reproductive aging, said Mak.

For example, from the time a woman first becomes reproductive — so has her first period — we’re in our reproductive portion of our life,” she said. “Some of the hormones during that time actually protect women somewhat from things like vascular disease .”

“[This] is why as we grow a bit older, men experience things like coronary artery disease a little bit earlier than women do, because they don’t have that protection.”

But when women become perimenopausal they lose some of those protective hormones, said Mak.

“When they lose some of that protection, they actually experience the effects of chronological aging slightly different from men,” she said.

Addressing the gaps in knowledge

That’s especially important to understand given the lack of research in women’s cardiovascular health.

“Because the manifestations are different and we age differently and perhaps women experience some of those diseases at a later date, we only found out after doing these studies properly that women were just as affected as men were.”

Dr. Veronique Roger, a cardiologist and senior investigator with the National Heart, Lung, and Blood Institute in Bethesda, Md., said Mak’s research is “critical.”

“She deserves an enormous amount of credit and to be congratulated for addressing these knowledge gaps with the needed scientific rigor,” she told The Current‘s Matt Galloway.

A doctor checks the pulse of a female patient as she sits on an examination table.
Moving forward, cardiologist Dr. Susanna Mak says it’s important for the scientific community to ‘recognize what’s been missed in the past’ in order to bridge the gaps that exist in women’s cardiovascular health. (S_L/Shutterstock)

Roger said there are several factors that have contributed to the knowledge gap in women’s cardiovascular health, such as most test animals being male and reluctance from women volunteers to participate in studies.

“Then, also, that the investigators, the scientists would not recognize the critical importance of parity in this engagement in research and therefore would not deploy the methods to be able to reach out to women as they reach out to men for enrollment and study, ” she said.

A key reason why this gap is difficult to address though, according to Roger, is the lack of awareness among women of the importance of heart disease for their health. She says the community is “losing ground in the percentage of women who are aware of that.”

“It’s important to raise this awareness among women because when one presents with some forms of cardiovascular disease, several of them actually present acutely,” she said. “Very effective treatments that we have are very time sensitive.”

“So if a woman — or man, for that matter — is sitting at home and experiencing symptoms that could either make them think that they have something wrong with their heart or a stroke or their brain, it’s very important that they seek medical care in a very timely fashion, urgently so that these time-sensitive treatments be used.”

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Diversity in the field

Moving forward, Mak says it’s important for the scientific community to “recognize what’s been missed in the past.”

“Where we see the gaps, where we see that women were underrepresented, then it is important to go back and repeat some of those experiments and ensure that women are properly represented and properly understood,” she said.

For Roger, part of the solution is also having more diversity in the field.

It’s been recognized that diversity … is really critically important — having more women cardiologists and having a more diverse population of cardiologists, including race and ethnicity,” she said.

“There’s scientific evidence that the relationship with patients will build in a more trusting way and therefore a more effective way when men and women or members of certain racial and ethnic groups can identify with their providers.”

Produced by Enza Uda.

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