American Heart Month recently concluded with calls from celebrities, doctors, politicians, and others to make Americans, especially women, aware of their risks of cardiovascular disease and equipped to take action. Preventing heart disease is a critical strategy for improving health outcomes and accelerating our economy. But the truth is, even when women are being proactive about their heart health, they are frequently misdiagnosed and undertreated because their specific risks haven't been studied and aren't yet understood.
Beyond raising awareness, we need better research and better tools that provide a more personalized approach to identifying heart disease risks in women and men.
Gender Differences in Cardiovascular Disease
Up to 20% of coronary events in women occur in the absence of known risk factors. At the same time, many women with established risk factors for heart disease don't experience any coronary events. This points to a glaring issue: our current methods for assessing risks of heart disease may not actually be working to predict risks for women. Until now, researchers simply haven't deeply studied the differential risks women face and translated that knowledge into a tool that helps doctors better predict and respond to a woman's risk for cardiovascular disease. It's absolutely urgent that we do this work now.
Even in 2020, the year of the COVID-19 pandemic, heart disease and stroke remained the number one killers of Americans, both men and women, at a huge cost. Each year, heart disease and stroke kill roughly 870,000 Americans, costing our health system $214 billion and causing $138 billion in lost productivity in our economy. COVID-19, in fact, can also negatively affect the heart by causing inflammation and increasing the risk of blood clots.
The data is clear that women show different symptoms, responses, and outcomes for heart disease when compared to men. Scientists have known for a long time that women sometimes present with different heart attack symptoms, such as pain or pressure in the lower chest and upper abdomen, pain between the shoulder blades, fainting, indigestion, and fatigue. Survival rates for women are lower during the first year after a heart attack, even after accounting for age differences, and after five years 30% more women than men will die or suffer from a stroke or heart failure. Studies have also found that women's pain is less likely to be taken seriously by doctors, and they are likely to wait longer to receive medication.
Research and Technology Make a World of Difference
Recent advances in personalized medicine are leading to a growing understanding that the factors and pathways – not just the symptoms – in cardiovascular disease for women are different than for men. Women are less likely to have the classic types of blockages that doctors see in men, and scientists suspect women are more likely to have issues in smaller arteries that aren't imaged as well. At the same time, associations between coronary artery disease and conditions that occur only in women, like endometriosis and certain pregnancy conditions, provide additional differential risks that need to be examined.
Research that helps us understand these differential pathways and associations will help inform better models for risk identification and prevention – models that actually work to predict a woman's likelihood of developing heart disease.
With newer technologies, we can also look at the downstream consequences of different genes. By studying proteins and metabolites in blood samples from patients who have heart disease and comparing them with those who do not, we can identify potential novel biomarkers that can be used to predict cardiovascular risk in women. Novel proteins we identify in the process can also instruct us in identifying additional contributing pathways and prevention strategies. At the same time, by looking at these same individuals' biological responses to diseases and environmental influences, through measuring metabolites, we can identify even more risk markers.
These novel markers will help to create better risk scores that are tailored to women. Clinicians in turn can use this information to better predict an individuals' risk and suggest modifications and medications earlier. This personalized risk information will usher in huge advances in preventing heart disease in both men and women, improving our health and our economy.
This research is long overdue, and given the lives at stake and the economic cost, it is urgent that we make rapid advances.