Research into Heart Disease Has Historically Focused More on Men

Published in partnership with , a nonprofit newsroom dedicated to the coverage of women’s issues around the world.

Katherine Fitzgerald had just arrived at the party. Before she could even get a drink, she threw up and broke out in a sweat. “I was dizzy. I couldn’t breathe. I had heart pain,” Fitzgerald says.

She knew she was having a heart attack.

What she didn’t know then was that the heart attack could have been prevented. Fitzgerald, a health-conscious, exercise-loving lawyer, should have been taking statin drugs to stop the buildup of plaque in her arteries that caused the heart attack and two others that followed.

Fitzgerald’s case illustrates a dangerous gap in medical care between men and women. While they are equally likely to suffer heart attacks, women are from theirs. It’s one of the many symptoms of the .

Life-saving statins, like so many other medications, have been developed based on clinical trials that primarily recruited men. As a result, many women like Fitzgerald don’t receive prescriptions for the drugs that could help them the most, says Dr. Laxmi Mehta, director of Preventative Cardiology and Women’s Cardiovascular Health at The Ohio State University.

“There were a lot of trials. But women weren’t included as much,” says Mehta, who serves on the American Heart Association’s Science Advisory Group. When women need treatment for heart conditions, she says, “we are assuming we are providing the best care based on data from men.”

More than 30 years ago, Congress directed the National Institutes of Health to include as many women as men in clinical trials. But while some progress has been made, equity remains elusive. And that’s dangerous for women. “Since 2000, women in the United States have reported total adverse events from approved medicines 52% more frequently than men, and serious or fatal events 36% more frequently,” research firm McKinsey & Company said in .

Now, the Biden administration is taking a run at it.

Last year, the administration established and, in February, it announced it would be dedicating $100 million to the newly formed Advanced Research Projects Agency for Health (ARPA-H) to to increase early stage research focusing on women.

“For far too long, scientific and biomedical research excluded women and undervalued the study of women’s health. The resulting research gaps mean that we know far too little about women’s health across women’s lifespans, and those gaps are even more prominent for women of color, older women, and women with disabilities,” Biden said in an signed in March.

Heart disease should be a bright spot in this black hole of medical research. It was in the 1980s that heart disease was killing women at similar rates to men that kickstarted passage of the 1993 law requiring equity in clinical trials. The American Heart Association has spent decades funding research and about women’s risks.

But gaps persist, says Dr. Martha Gulati, president of the American Society for Preventive Cardiology and a cardiologist at Cedars-Sinai Hospital in Los Angeles. “We don’t get represented in trials,” Gulati told a seminar sponsored by the Society for Women’s Health Research in February.

One example: Dr. Safi Khan of West Virginia University and colleagues reviewed 60 trials of cholesterol-lowering drugs conducted between 1990 and 2018. Not even a third of the people enrolled—28.5%—were women, they in JAMA Network Open in 2020. The trials’ findings likely did not accurately represent the public as a whole, they say.

“Medical research is several steps behind on women and heart disease, and that is a major contributor to ongoing ignorance about the problem on the part of both the public and a range of medical professionals,” says Dr. Harmony Reynolds, a cardiologist at NYU Langone Health. “Everywhere along the way, there is different treatment for women, and there is some bias there.”

Statins have been widely described , of major heart events such as heart attack or stroke . Women. And when they do take them, women are because of perceived side effects. But no major study digs into the actual rate of side effects among females, or what might lie behind such differences.

Further studies might uncover additional benefits, says Dr. JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. There are hints that statins might lower a woman’s , including

Failure of recognition

Fitzgerald was 60, had higher-than-optimal blood pressure, unhealthy levels, and a family history of heart disease, says Reynolds, Fitzgerald’s new cardiologist. “Katherine had multiple risk factors. Many of my patients are told their blood pressure and cholesterol are ‘borderline’ when really they should be treated,” she says.

Doctors often blame women for failing to recognize their own heart disease symptoms, but the evidence shows medical professionals miss them, too.

The symptoms of heart attacks in men are widely known: crushing chest pain, a telling sensation in the left arm, or sudden collapse. Women, on the other hand,

Fitzgerald did recognize her symptoms. At the party where she suffered her first heart attack, she begged for an ambulance. But other guests, including a physician friend, said they didn’t think she needed medical attention.

When paramedics finally arrived, they, too, dismissed her fears and diagnosed a panic attack. They sent her home. “If I had been a man, there is no way the paramedic wouldn’t have taken me to the hospital and I wouldn’t be in the mess I am now,” Fitzgerald says.

Fitzgerald waited two days to visit an emergency room. By then, some of her heart muscle had died. She received two stents to hold open clogged arteries, but suffered two more heart attacks in the following months. She now stays out of the courtroom and sticks to less-stressful desk work.

“I take care of all these young women with heart attacks and I hear so many stories about people saying they were ignored,” says Reynolds.

Waiting for attention

The problem is not just anecdotal. Reynolds and colleagues by looking at more than 29 million emergency room visits by people under 55 reporting chest pain.

“In that study we show young women coming in with chest pains and they are waiting longer to be seen,” Reynolds says. “The women are waiting too long and women of color were waiting even longer. So we know there is some subtle bias there.”

Doctors can use to try to a patient’s future likelihood of heart disease and treat accordingly. But Dr. Stephanie Faubion, medical director of the , says they do not work well for women.

“That is because we are still using those that were developed and made for men,” says Faubion, who is also director of the Mayo Clinic Center for Women’s Health in Jacksonville, Florida.

Women have many specific heart risks. They have , thinner heart walls, and suffer more heart damage from diabetes. Pregnancy in various ways. Autoimmune diseases such as rheumatoid arthritis also add heart disease risks, and women are far more likely than men to have these conditions.

Women who start menstruation early, or who reach menopause early, have higher heart disease rates. Birth control pills can raise the risk for blood clots, strokes, and heart attacks.

Perhaps the most recent instance of women being left out of heart disease research can be seen in the trials of highly popular diabetes drugs such as semaglutide, sold under the brand names and .

The drugs cause dramatic weight loss, which made researchers wonder if they might lower heart disease rates, too. according to, and the U.S. Food and Drug Administration their use to prevent heart disease.

But none of the weight-loss trials, published in prestigious medical journals such as the New England Journal of Medicine and the Journal of the American Medical Association, break out separate data on men and women. And while the weight-loss studies did include far more women than