Your Biggest Risk Factor for Heart Health? Decades of Neglect from the Medical Community (Part I)
Tis the season of love, broads, and that includes loving yourself enough to know some pretty important information about your heart health, including how the scientific and medical professions are only recently thinking about how women are . . . not men. This two part series from broad Lisa Ingarfield sheds light on the intersection of medicine and sex differences. Part 1 covers the history of women’s exclusion from medical research, leading to a significant lack in understanding the role of sex differences in risk and treatment. Part 2--running next week--explores how misunderstanding sex differences leads to routine misdiagnosis in women because the medical profession still uses men as the benchmark for disease identification/treatment.
Lisa Ingarfield | @tritodefi
Broads, how much do you know about your risk of heart disease? Did you know your risk of heart disease goes up as you age, and also if you have type I diabetes or rheumatoid arthritis? Did you know that the symptoms you may experience with a heart attack are not those we consider “classic,” such as a tight chest or radiating pain down your left arm? It turns out, there are several sex differences associated with heart disease women we are largely uneducated about. That is because the predominant narrative about heart disease has been authored by men, for men.
Sexism, Science, and the Implications for Women's Health
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, few medical research studies included women. Most clinical trials or studies investigating risk factors and treatment for all kinds of diseases only studied (white) men. Women were systematically excluded up until the 1970s because the Federal Food and Drug Administration (FDA) mandated that any woman of childbearing age could not participate in phase 1 or phase 2 clinical trials. It didn’t matter whether the women didn’t want to have children, were single, or weren’t sexually active. It didn’t even matter if they were married and their husband had a vasectomy. If they were of childbearing age, the risk was too great to include them in studies, said the all-male FDA. Oh, and there’s that whole thing of the accounting for the menstrual cycle, and men didn’t want to touch that with a ten-foot pole.
The Exclusion of Women
For decades, research findings about heart disease in men (including studies on aging and other illnesses) were extrapolated to women. Thus, the landscape of understanding disease, risk factors, and effective treatment for women has been slow to develop. When women were finally included in small numbers in clinical trials in the late 1970s, it was predominantly white women, and women associated with the male participants already in various studies.
Heart disease, a term encompassing all diseases of the heart, including heart failure and coronary artery disease, which leads to heart attacks, peaked in the 1950s and 1960s. At this time, the medical field (comprised largely of men), believed it was largely a men’s disease and women didn’t really have to deal with it. But heart disease is the number one killer of men and women in the United States. According to the American Heart Association, “More than one in three female adults has some form of cardiovascular disease” (which includes heart disease and all other diseases affecting the heart and blood vessels). This equates to about one woman dying every minute. Heart disease in particular, is deadlier for women than all forms of cancer combined but we don’t give it as much attention. In fact, more women will die from heart disease than men, in part because women are living eight to ten years longer. So, broads, we need to be paying attention!
Let’s Hear it for Colorado! Policy Change
Here’s a little bit of interesting history for you to further set the scene: because the research in this area has been so sparse, the National Institutes of Health (NIH) implemented a 1986 rule, requiring all studies to include women. However, their application and enforcement of this rule was disparate. In 1990, Colorado congresswoman Pat Schroeder (let’s hear it for Colorado!) and other congresswomen from the Congressional Caucus for Women’s Issues were instrumental in triggering Congressional hearings on this problem. Schroeder also introduced the Women’s Health Equity Act in 1990 with several co-sponsors including both Democrats and Republicans. The bill required the establishment of an Office of Research on Women’s Health at NIH and the inclusion of women and people of color in research in equal numbers to men and white people. Rather than wait for the bill to pass (which it didn’t in its comprehensive form), the NIH, under pressure from the Congressional hearings, established the office anyway. The Bush (Sr) administration also implemented the Women’s Health Initiative, a $625 million, 14 year research endeavor to study prevention of heart disease, breast cancer, and osteoporosis in women (see Joan Lowry’s book, Pat Schroeder: A Woman of the House, for more information on her efforts).
As the nineties progressed, things began to look up for medical research focusing on women. However, there is still a long way to go to fully understand the relevance of sex differences in risk and prevention of heart disease for women.
Tune in next week for Part II of this important exploration of sexism in science and the real consequences for women’s health.