Women Too Often Missing from Heart Disease Research

At the same time, cardiovascular disease is still women’s deadliest foe.

female doctors at laptop discussing

Medically reviewed in March 2022

Updated on March 17, 2022

Every 80 seconds, a woman dies from cardiovascular disease. In fact, it's the number-one killer of women around the world, taking more lives than all forms of cancer combined. It’s the leading killer of new mothers, too, with Black women dying at much higher rates than white women.

With staggering statistics like these, you’d think heart disease research would include a proportionate number of women. According to the American Heart Association, however, women make up only 38 percent of all participants in recent heart disease- and stroke-related clinical trials. For heart attack studies, the number is less than 27 percent.

“It is mind-boggling that women comprise 50 percent of the population, yet we are remarkably understudied,” says cardiologist Rachel Beck, MD, of Methodist Hospital 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 cardiologist Saritha Dodla, MD, of Medical City Alliance 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.”

For instance, 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.”

Article sources open article sources

American Heart Association. Go Red for Women. The Facts about Women and Heart Disease. Accessed March 11, 2022.
American Heart Association. Women still underrepresented in clinical research, science and medicine that could save them from their No. 1 killer. February 17, 2020.
Putting gender on the agenda. Nature. 2010;465(7299):665.
DeVon HA, Rosenfeld A, Daya M. Cardiac Symptoms in Women and Men. JAMA Intern Med. 2013;173(20):1927–1928.
Centers for Disease Control and Prevention. Women and Heart Disease. Page last reviewed January 31, 2020.
American Heart Association. Warning Signs of a Heart Attack. Accessed February 11, 2022.
American Heart Association. Heart Attack Symptoms in Women. July 31, 2015.
Mirin AA. Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health. J Womens Health (Larchmt). 2021;30(7):956-963.
US Department of Health and Human Services. OASH, Office on Women’s Health. Policy of inclusion of women in clinical trials. Page last updated April 1, 2019.
NIH Grants and Funding. Inclusion of Women and Minorities as Participants in Research Involving Human Subjects. Updated February 9, 2022.
Trent Haywood. Not Just A Man’s Problem: The Deadly Cost Of Underestimating Women’s Heart Disease. Health Affairs. September 29, 2015.
Johns Hopkins Medicine. The Ciccarone Center Women's Cardiovascular Health Center. Heart Disease Risk Factors in Women. Accessed March 11, 2022.

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