Heart Health and Risk (Part II)

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Tomorrow is Valentine’s Day. And here at The Broadview, we can’t think of a better way to show you we love you, Denver broads, than with some info on how to take care of yourselves and those big, beautiful, mile high hearts. This is Part 2 of our two part series on the intersection of medicine and sex differences. If you missed it, read up on Part 1 and the history of women’s exclusion from medical research, resulting in a lack of appreciation for the role sex differences in heart health. In Part 2, broad Lisa Ingarfield explores how men remain the benchmark for heart disease, and what that means for women.

Lisa Ingarfield | @tritodefi

The history of women’s exclusion from medical research is long and broad, but after several congresswomen drew national attention to this omission in the 1990s, things began to shift. Heart disease is not just a men’s issue, nor is it an issue women should only think about as they grow older.

As we learned in Part 1 of my series, the very thing males scientists sought to avoid in the medical studies--women’s menstrual cycles--is the exact thing, according to Dr. Janet Snell-Bergeon, a researcher and associate professor of Pediatrics and Epidemiology at the School of Medicine and Colorado School of Public Health at the University of Colorado, that holds the key to understanding the many sex differences in disease risk and treatment for women.

It’s in the Sex Hormones

Women with type 1 diabetes have about a four-fold increased risk of developing heart disease compared to women without type 1 diabetes, twice the increase in risk seen in men. Estrogen and testosterone appear to be central to why some women are protected against heart disease as compared to men, and may explain why women with type 1 diabetes in particular are at higher risk, as insulin affects bioavailable estrogen and testosterone production.  

Since her PhD research wherein she first investigated sex differences and the link between heart disease risk and type 1 diabetes, Snell-Bergeon has continued her research in this area because she sees a critical need. She is attempting, like many other women researchers, to address this dangerous imbalance in knowledge so pervasive in the medical profession. Her current research includes looking at the connection between menstrual cycle sex hormone production and cardiovascular risk.

Specifically, Snell-Bergeon is looking at the relationship between sex hormones, insulin, and heart disease in women with type 1 diabetes. She is also working on a study that manipulates the amount of estrogen in a woman’s system to learn if women with type 1 diabetes are not creating as many estrogen receptors in their blood vessels, and thus, are at greater risk for developing heart disease. Coming from your non-scientist writer, I found it fascinating, even if I needed it explained more than once.

The Epidemic of Misdiagnosing Women

An horrific example of the profound effect this widespread misunderstanding of sex differences in heart disease--and heart attacks in particular--has had on women’s health, is the sheer number of women who are misdiagnosed when presenting at a medical facility. Beatrice Vance died in the ER after complaining of “nausea, shortness of breath, and chest pain” rating her pain as a 10 on a scale where 10 is the highest. She was left untreated and unsupervised for two hours because hospital staff didn’t take her complaint seriously. Women presenting with “non-traditional” (so again, non-male) symptoms of a heart attack are told perhaps it’s something they ate, or an anxiety attack, or they are simply overreacting.

According to a study from Leeds University in the U.K., women are two times more likely to be misdiagnosed as compared to men. The Atlantic also explored this persistent refusal to investigate possible heart attack symptoms in women as a possible heart attack, relaying “thousands of American women with heart disease are misdiagnosed every year, often with fatal consequences.”

Fatal consequences. Let that sink in. Women are dying because the medical profession doesn’t understand sex differences in heart attack and heart disease symptoms, and applies a male standard of symptom identification to women’s health concerns. Another important consideration, Snell-Bergeon highlights, is women tend to fair more poorly after a first instance of heart disease than do men, and are more likely to die from a first heart attack as compared to men. Understanding our unique risk factors is therefore crucial for us and for the medical profession.

Women in Medicine Make a Difference

More women getting into medicine and research has certainly had a profound effect on the state of research into women’s specific risk factors and disease management, says Snell-Bergeon. The NIH Office of Research on Women’s Health (ORWH) mandates that research studies must investigate sex differences to receive NIH funding, which has also had an effect. Yet, the information is still slow to trickle down to the general public. So much so, the American Heart Association created Go Red For Women, a site entirely dedicated to assist women in understanding their risk for heart disease and how to effectively mitigate it.

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There is no such site for men, because men’s experience of heart disease has long been considered the universal heart disease experience. There was no clearer example of this for me than in symptoms of a heart attack. I have been taught one thousand times over that major signs of a heart attack are: pressure in the chest, radiating pain down the left arm and jaw, and shortness of breath. Not so for women. While some women certainly do experience these symptoms, the most frequent symptoms for women include fatigue, nausea, fainting, and lightheadedness. Broads, did you know that? I didn’t.

Prevention and Advocacy

As for what we can do broads, Snell-Bergeon urges us to ensure we are thinking about heart disease even if we are in our twenties. If you have diabetes or other diseases, pay attention to how they may increase your chance of developing heart disease. Exercise, maintain a healthy body weight, quit smoking (or don’t start), and get your cholesterol and blood pressure checked regularly. All of the above are good preventative measures. Heart disease takes decades to develop, so thinking about mitigating risk early, and engaging in prevention activities is an important thing for us broads to do.

Additionally, Snell-Bergeon encourages women to advocate for themselves if they are concerned they are experiencing a heart attack or other cardiovascular event. If a medical provider dismisses you, ask for another medical provider. Educate yourself on the symptoms women experience, not those based on research about men and assumed to be the norm for everyone. Speak to your representatives about NIH funding. The current White House budget proposal slashes NIH funding by 18% which would set us back decades in enabling researchers like Snell-Bergeon to continue research on women.

Women’s health, effective treatment and risk identification cannot be understood without research that’s inclusive of racially diverse women, across all age ranges. We have been so slow to recognize the relevance of sex differences in understanding disease, we cannot stop now.