Heart disease is the leading cause of death for both men and women in the United States, but historically—and even today—women are underrepresented in heart disease research, can be overlooked in the clinical care setting when it comes to cardiovascular care, and too many women in the United States (44%) do not recognize heart disease as their number one killer.
Women have historically been left out of cardiovascular research, and medical research generally, due to a belief that studying females would be difficult due to female hormones, or that it may harm women and their future fertility. We now know these beliefs to be false, but the assumptions have left their mark on research:
- Women represent just one-third of the study population in most cardiovascular trials,
- Women are underrepresented in ischemic heart disease clinical trials, and
- Women make up just 24% of heart failure trials.
As these gaps in research make their way through the health care system, they have implications for patient outcomes, likely affecting the way both providers and patients think about heart disease. This plays out in the health care setting in the following ways:
- Women experiencing chest pain wait 11 minutes longer to get care in the emergency department than men with the same symptoms,
- Women of color are more likely to have their complaints trivialized by health care professionals compared to other groups, including men and white women, and
- Women are less likely to receive guideline-directed therapies and interventions for heart disease compared to men.
Another challenge to improving upon these outcomes is that only 13% of cardiologists are women, and women remain underrepresented in cardiovascular research leadership and publications.
It will take a comprehensive and multidimensional approach – from additional women-focused health care provider education, to improved clinical trial diversity, to culturally sensitive and tailored public education resources, to greater policy support – to improve women’s heart health outcomes.
Earlier this year, the Society for Women’s Health Research released a heart health policy agenda that outlines several ways that we tackle the gender disparity in heart health. Among the recommendations made are to:
- Raise public awareness of heart disease by conducting a federally led, public awareness campaign on heart health.
- Increase diversity across all levels of science by reintroducing and passing the Diversifying Investigations Via Equitable Research Studies for Everyone (DIVERSE) Trials Act.
- Address gender bias through training in health professions education by integrating sex and gender differences training throughout medical curricula.
- Feature women prominently in cardiovascular clinical guidelines (and in some cases as the focus)– not as an afterthought or special patient group.
- Make patients the center of the care plan by encouraging open communication between providers and individuals to ensure personal preferences, values, and lifestyle factors are considered.
- Modify utilization management and other insurance policies to support patients’ needs, including through passing the Safe Step Act of 2023 and building in protections for patients from non-medical switching, allowing them to have stability in their treatment plans and options.
- Develop comprehensive patient-centered approaches to address social determinants and root causes of heart disease, such as protecting access to food security and programs like the Supplemental Nutrition Assistance Program (SNAP); creating interventions that are culturally sensitive and tailored to local demographics; and integrating overall wellness (physical activity, nutrition) into medical curricula, to eventually move us towards a more preventive health care system.
These recommendations represent just some of the changes that are needed to meaningfully improve women’s heart health outcomes across the lifespan. Read the recommendations in the policy agenda, “Improving Women’s Heart Health Outcomes Across the Lifespan.”
Heart disease is considered an “invisible illness”; it is not visible to others and may be difficult to diagnose. But by championing heart health—by raising awareness among women about their personal risk for heart disease and ensuring that diverse populations of women are sufficiently represented in cardiovascular clinical trials—we can reduce the disease burden of heart disease in the United States and save lives.
Improving heart health research, treatment, and education for women is a rising tide that will lift all of us. Join SWHR this Women’s Health Month and all year long as we work toward a society where cardiovascular health is prioritized and supported at individual, community, and systemic levels.