Part 1: Discrepancies Between Men and Women with Heart Disease

I started researching one topic but fell down a rabbit hole and discovered far more that I gotta share so this is a two-parter

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Quick Note: When I use the term “woman” in this article, I’m referring to anyone who menstruates, but I acknowledge that not all people who menstruate identify as women and not all people who identify as women menstruate.

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Hiya!

While several cardiovascular diseases exist, they’re often collectively known as “heart disease.” A common aspect of heart disease involves cholesterol and fats accumulating as plaque in the heart’s arteries. This plaque build-up restricts the flow of oxygen-rich blood to the cardiac muscle, weakening it over time and leading to heart failure, such as a heart attack.

Heart disease is the number one cause of death for adults in the United States (and the world). Recent research found that while women are diagnosed with cardiovascular disease less often than men, they have a higher rate of death from it. Yet, males are diagnosed and treated for it significantly more often than females.

A Man’s Disease?

Experts know much more about heart disease now than a century ago. Back then, so little was known about the disease that a diagnosis resigned men to years of bed rest or an early death. I say “men” because it was assumed that heart disease was a “man’s disease” that didn’t affect women.

In fact, American society thought women's only role in managing heart disease was caring for the men in their lives who had it.

Seriously.

Even as late as the 1960s, the American Heart Association hosted a conference themed “How Can I Help My Husband Cope with Heart Disease?” and published a nutritional pamphlet titled “The Way to a Man’s Heart.”

A big reason for this out-of-touch assumption was due to a severe lack of funding and research for any medical conditions involving women — unless it concerned reproduction.

Further, as Gina Lundberg, clinical director of the Emory Woman's Heart Center and a professor at Emory University School of Medicine in Atlanta, explained to Laura Williamson of the American Heart Association, it was assumed that women had natural hormonal protection from heart disease until they reach menopause.

The hormone of interest was progesterone, which plays a key role in the menstrual cycle and pregnancy. However, progesterone is not exclusive to females — it also helps produce testosterone in males. That said, females produce more of the hormone than males, and research indicates that it does indeed aid in heart health, so there’s a seed of truth behind the assumption.

Anyway, it wasn’t until just a few decades ago, during the mid-1980s, that anyone began seriously considering how heart disease might actually affect women.

The shift occurred when the Framingham Heart Study, the first in-depth and long-term cardiovascular analysis in the United States, reported sex-specific patterns related to heart disease and began questioning whether its effects on women were being overlooked.

The study pointed out that previous research included an “insufficient” number of women and failed to assess sex differences in heart disease adequately. This error contributed to the assumption that heart disease only affected men because only men were being studied.

So, people like cardiologist Nanette Wenger, one of the first women to attend Harvard Medical School, began demanding greater inclusion of women in medical research to understand the unique way cardiovascular disease affects females. Wenger and others pushed for the National Institutes of Health (NIH) to include women in funded research.

The NIH officially wrote such a policy in 1989, and it was signed into law in 1993. However, Wenger later stated that the legislation “had no teeth,” and treatments for heart disease in women continued to be based on evidence that came from studies predominantly focused on middle-aged White men.

A professor of cardiology and associate dean for faculty affairs at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, Jennifer Mieres, told Williamson:

"We thought that you could treat men and women the same. We had great advances in treatment strategies, but we were applying a one-size-fits-all approach and clearly that wasn't working."

So, researchers needed a new approach to better understand how heart disease affects women.

A New Approach