‘Alarming gaps in knowledge’: Exploring the intersection of reproductive health and the heart
Key takeaways:
- Disease states unique to women can raise risk for heart disease.
- More tailored tools for assessing women’s heart health are needed, as is more research on female-specific risk factors.
Recent research reported that women with endometriosis have an approximately 20% increased risk for stroke and a 35% greater risk for heart attack compared with women without endometriosis.
Although this research, presented at the European Society of Cardiology Congress in September, is not definitive, it raises yet another disease state unique to women that may increase CV risk alongside other conditions such as gestational hypertension, gestational diabetes and preeclampsia.
Female-specific conditions contribute to heart disease, yet the mechanisms driving this connection remain unclear. What’s more is that while CVD is responsible for one in three deaths in women in the U.S. each year, only 38% of participants in CVD trials are women.
This calls for increased education and research around female-specific risk factors, and tailored tools for assessing women’s CV health to help improve health outcomes.
Historical gaps in previous research
For too long, women have been underrepresented in health research, particularly before 1993, when women were rarely included in clinical trials. The previously held thought was that women were viewed as simply “small men,” but we now know women’s biology is different. This imbalance in research limits our true understanding of the differences between women and men, their risk factors and their need for different testing modalities and treatments. It ultimately impacts health outcomes for women.
The alarming gaps in knowledge are only further exasperated when seeing that 60 million women (44%) in the U.S. today live with some form of heart disease, and research has shown that women tend to be more prone to strokes than men. We now recognize that some of the reasons for differences in women’s CV health may be due to their experiences during pregnancy and menopause.
Connecting reproductive health and heart disease
Gestational hypertension, preeclampsia and gestational diabetes can be indicators of women’s future CV risk. Studies show that women who develop preeclampsia during pregnancy face a two to four times greater risk for chronic hypertension, heart disease, stroke and diabetes within 10 years of giving birth.
I often explain that pregnancy is like a CV stress test — unlike a typical stress test, which may involve running 10 to 15 minutes on a treadmill, pregnancy is a stress test that lasts 40 weeks. While we are still learning about how pregnancy may cause long-term effects, data clearly show reproductive health plays a role in a woman’s CV health risk.
Reproductive health goes beyond just pregnancy. It includes factors such as menopause that can also be a time of risk for CVD. While there are still gaps in the current knowledge, there is growing research aiming to fill these gaps by understanding the unique concerns women encounter during menopause, including the risks and benefits of hormone therapy and ties to heart disease.
Tailored tools and solutions
Building a bridge toward personalized and insightful care requires the right tools. As data continue to be collected, it is clear that there is a significant need for updated risk assessment tools for women; especially those that incorporate nontraditional CV risk factors such as gynecological and obstetric history. With new measurement tools, providers could yield better insights and more accurate CV risk scores — estimating the likelihood of having a heart attack or stroke based on more comprehensive risk factors, in addition to the traditional risk factors included in current risk scores.
The risk tools used today do not account for nontraditional risk factors, like preeclampsia, gestational diabetes, gestational hypertension and inflammatory conditions. In addition, many routine checkups lack questions about a patient’s reproductive health or account for factors like stress and anxiety, which play a part in CV health and risk reduction, especially in women. The development and implementation of more comprehensive tools could lead to more accurate risk scores and earlier interventions.
Multidisciplinary, collaborative care
During the past 2 decades, there’s been increased interest in studies evaluating female-specific risk factors. While this is progress, more needs to be done, starting with a better understanding of the connection between reproductive health and CVD.
This can be achieved through a multidisciplinary approach. One disease doesn’t just belong to one specialist. Many of the conditions affecting women cross over multiple specialties. My goal is to create multidisciplinary programs and work toward a one-stop shop for women who have these conditions.
Ultimately, the best model of care for patients is collaborative — one that looks at breaking these barriers. By encouraging collaboration and the implementation of proper assessment tools and approaches, we can offer more insights that lead to personalized care; helping women manage their CV risks more effectively.
The study showing that endometriosis is associated with elevated risk for heart attack and stroke is yet another reminder that there are still more data left to be learned about women and how their reproductive and gynecologic health may affect their future risk for CVD. Although this study alone is not definitive and more studies will be needed to confirm these findings, it certainly opens up even more questions about women’s unique risk factors and the need to look beyond traditional and male-focused views of CV risk assessment.
References:
- American Heart Association. Women and stroke. https://www.stroke.org/en/about-stroke/stroke-risk-factors/women-have-a-higher-risk-of-stroke. Accessed Jan. 8, 2025.
- Atlantic Health System. High blood pressure during pregnancy: What you need to know. https://ahs.atlantichealth.org/about-us/stay-connected/news/content-central/2024/pregnancy-high-blood-pressure.html. Published Sept. 27, 2024. Accessed Jan. 8, 2025.
- CDC. About women and heart disease. https://www.cdc.gov/heart-disease/about/women-and-heart-disease.html. Published May 15, 2024. Accessed Jan. 8, 2025.
- Cleveland Clinic. Cardiac risk calculator. https://my.clevelandclinic.org/health/articles/17085-heart-risk-factor-calculators. Accessed Jan. 8, 2025.
- Havers-Borgersen E, et al. Cardiovascular disease in women (5). Presented at: European Society of Cardiology Congress; Aug. 29-Sept. 2, 2024; London.
- Jin X, et al. Circulation. 2020;doi:10.1161/CIRCULATIONAHA.119.043594.
- Mastroianni AC, et al. Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies: Volume I; Institute of Medicine Committee on Ethical and Legal Issues Relating to the Inclusion of Women in Clinical Studies. Washington, D.C.: National Academies Press; 1994. https://www.ncbi.nlm.nih.gov/books/NBK236531/?report=reader. Accessed Jan. 8, 2025.
- Williamson L. The connection between menopause and cardiovascular disease risks. American Heart Association News. https://www.heart.org/en/news/2023/02/20/the-connection-between-menopause-and-cardiovascular-disease-risks. Published Feb. 20, 2023. Accessed Jan. 8, 2025.
For more information:
Amy M. Ahnert, MD, is director of the Women’s Heart Program at Morristown Medical Center, Atlantic Health System. She can be reached at Women’s Heart Program, 111 Madison Ave., Suite 301, Morristown, NJ 07960; email: Amy.Ahnert@atlantichealth.org.
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