What the 2011 10Q Report means for women’s cardiovascular health

In June, the Society for Women’s Health Research and WomenHeart, the National Coalition for Women with Heart Disease, released the 2011 10Q Report: Advancing Women’s Heart Health through Improved Research, Diagnosis, and Treatment.

Information on the current status of cardiovascular disease and cardiovascular research in women provides the background data for the specific items addressed in the report.

The following items represent a consensus by leading experts in women’s CV health of the 10 most important questions related to CV care for women (forming the “Q” in the 10Q report):

Nanette K. Wenger

• What factors influence or explain disparities in CVD epidemiology and disease outcomes between men and women?
• What are the best strategies to assess, modify, and prevent a woman’s risk of heart disease?
• What are the most accurate and effective approaches to assess and recognize chest pain and other symptoms suggesting coronary heart disease in women?
• What role does a woman’s reproductive history and menopausal hormone therapy play in the development of heart disease?
• What are the risk factors for CV disorders associated with pregnancy and how are they best treated?
• What is the best method for studying sex differences in vascular injury so that CV repair therapies may be improved?
• What are the most effective treatments for diastolic heart failure in women?
• Why are young women more likely than men to die after a heart attack or after surgical revascularization procedure?
• How do psychosocial factors affect CVD in women?
• What biological variables are most influential in the development and clinical outcomes of heart disease and what can be done to reduce mortality rates in women?

Taken with the answers, the report provides a roadmap for future research concerning women’s CV health and is a call to action to members of Congress, administration officials, research scientists, health care providers, and women and their families.

Magnitude of the problem

Heart disease is not predominantly a man’s disease, as was once erroneously believed. CVD is the leading cause of mortality for US women, responsible for more than 420,000 deaths each year. This means that every minute, one US woman dies of CVD. Since 1984, CVD has claimed the lives of more women than men each year. One of every two American women will die of heart disease or stroke, compared with one of 25 women who die of breast cancer. CVD is clearly a major health problem, yet CV research is substantially underrepresented in our national research budget.

Although in recent years the death rates from CVD have declined in women, there are warning signs of a reversal of this favorable trend. CVD death rates are increasing in young women, those younger than 55 years of age, likely fueled by the epidemic of obesity, sedentary lifestyle, and increased diabetes. With current and likely future financial constraints on research funding, it is imperative to appropriately focus research funding for heart disease in women, which is why this report identifies the top 10 questions requiring urgent answers.

The state of current CV research

Historically, medical research has neglected women. Gender inequities in biomedial research undermine the health care of women. In the landmark 2001 Institute of Medicine report, “Exploring the Biological Contributions to Women’s Health: Does Sex Matter?,” three issues were identified that specifically disadvantaged women: lack of analysis and reporting of data separately for women and men (this limits the researchers’ ability to identify potentially important sex and gender differences); a lack of health care quality measures for many conditions specific to or predominant in women; and failure to analyze sex- and gender-based differences in clinical care. Despite progress in reducing CVD mortality in women, disparities remain among women in specific population subgroups.

Women who are socially disadvantaged because of race or ethnicity, income level or educational attainment have been underrepresented in many research studies and thus have not benefited equally from the progress in women’s health research. This can, however, be remedied. Research dollars should be specifically targeted to minimize the burden of CVD in women, with the proportion of funding by the NIH for heart disease and stroke research increased to more accurately reflect the impact of CVD on morbidity and mortality rates in the US.

Sex-based discrepancies

Women are more likely than men to have delayed diagnosis or treatment due to MI symptoms that are overlooked or unrecognized. Women are less likely than men to receive timely CV diagnostic tests and are less often prescribed life-saving therapies with aspirin, beta-blocking drugs, or statins. In a national survey, only 53% of women said they would call 911 if they thought they were having a myocardial infarction. These items highlight the priority for heart health education both for women and for their health care professionals.

There are gender differences in the magnitude and the potential benefits and risks of preventive interventions for women. Sex-specific predictive tests and measures for the early detection of CVD in women have to be developed and refined. There is compelling evidence of the adverse impact that the pervasive disparities in CV health have on the clinical outcomes and quality of life of black and Hispanic women.

Despite known sex differences in symptoms and treatment, medical treatment of women has not changed substantially over time, nor has it resulted in appropriate research into the distinct CV sex differences in women.

An unmet need

Women are underrepresented in CV clinical trials, making it difficult for researchers and clinicians to draw accurate conclusions about the benefits or risks for a woman from a particular test, drug or device. Only one-third of the CV clinical trials report sex-specific results, despite the FDA and other federal regulations requiring sex stratification.

Conducting research sensitive to appropriate sex- and race/ethnicity-specific differences, along with analysis of CV trial results, has been difficult due to insufficient recruitment of women and minorities into these clinical trials. Improved participation rates of women and minorities in CV research would result in more appropriate prevention, early detection, accurate diagnosis and quality treatment of all women with heart disease. This would lead to the improved CV health of our nation.

Nanette K. Wenger, MD, is a professor of medicine at Emory University School of Medicine and a consultant to the Emory Heart and Vascular Center, in Atlanta.

Disclosure: Dr. Wenger reports no relevant financial disclosures.