Women too often missing from heart disease research

Every 80 seconds, a woman dies from cardiovascular disease. In fact, it's the top killer of women around the world, claiming more lives than all forms of cancer combined. It’s the number-one cause of deaths in pregnant people and new mothers, too, with Black women dying at disproportionate rates compared to other women.

With staggering statistics like these, you’d think heart disease research would include a proportionate number of women. However, according to a 2020 study in the journal Circulation, women made up just 38.2 percent of participants in heart disease- and stroke-related clinical trials between 2010 and 2017. For heart-attack studies, the number was less than 27 percent.

“It is mind-boggling that women comprise 50 percent of the population, yet we are remarkably understudied,” says Rachel Beck, MD, a cardiologist in San Antonio, Texas.

Because research sets the standard for prevention and treatment, this invisibility can mean serious consequences for women’s heart health.

The dangers of excluding women

It’s well known that cardiovascular disease (CVD) affects men and women differently. Though chest pain is the number one symptom in women as it is in men, women are more likely than men to have subtler symptoms of heart attack, such as indigestion, shortness of breath, and back pain. Women are also usually affected later in life and have some different risk factors for the disease. These include higher rates of depression, anxiety, rheumatologic diseases like lupus, and pregnancy-related factors.

When these biological differences aren’t taken into account, in research or in the doctor’s office, it puts women at risk, says Saritha Dodla, MD, a cardiologist in Fort Worth, Texas.

Dr. Beck agrees.

“What works for a man doesn’t always work for a woman,” Beck says. When women are excluded from research, she adds, they “may receive therapy that is ineffective or harmful, or they may be withheld therapy altogether.”

Research shows that after a heart attack, healthcare providers (HCPs) tend to treat women less extensively than they treat men. For example, women are less likely to get procedures to open up clogged arteries.

On the other hand, Dr. Dodla says, gender-specific research can help HCPs better understand how heart disease progresses in women, so they are better able to effectively diagnose and treat their female patients. More parity in research would also make it easier to educate female patients on their specific risk factors for the disease—and how to prevent it.

Why aren’t more women included in heart disease research?

Even though heart disease kills more women each year than men, it’s long been mistakenly considered a men’s health issue. That means that research efforts are continually skewed toward middle-aged males, according to both Beck and Dodla.

In fact, in 1977, the U.S. Food and Drug Administration issued guidance that barred women of childbearing age from participating in clinical trials. The aim was to protect them and developing fetuses, but the flipside was that research became one-sided from a gender perspective. (The FDA lifted the ban in 1993.)

Many trials’ criteria for participation don’t take sex sufficiently into account. For instance, if a trial excludes elderly participants, it may automatically reduce women’s enrollment in some cases because among older people with heart failure, there are more women than men. Trials led by men also seem to enroll fewer women, one study found. And it appears that fewer women than men get referred for potential participation in research trials in the first place.

Women are also thought to have less available time to participate due to family and childcare responsibilities. Evidence also suggests women may be more wary than men of participating.

Taking charge of your heart health

In light of all this, what can you do to protect your heart? Begin by being your own health advocate, says Beck.

“Women are urged to seek screening, know their family history, and take a proactive stance on their own health,” she says. That means educating yourself on the risk factors and symptoms of heart disease and doing your best to follow a heart-healthy lifestyle.

Also, talk to your HCP about having regular cholesterol screenings and blood pressure testing, says Dodla. Then ask what those results mean, and what changes you should make, if any.

“In order to effectively treat a condition, it must be considered early by the patients and practitioner,” says Beck. “Change is happening, but it will take more time.”