American Heart Month: A Time to Reflect
By Dr. Janine A. Clayton
As I recently reflected on American Heart Month, I thought about how our language demonstrates the importance of the heart, both physically and emotionally. Denoting the emotional symbolism of the heart, we say things like "straight from the heart," "having your finger on the pulse," "the heart of the matter," and more.
The importance of the heart to our physical life is, obviously, immense. Heart disease is the leading cause of death for women and men, and that is of great concern. But I'm happy to say that we've made progress when it comes to understanding the disease and how it differs for men and women.
The Framingham Heart Study and the Women's Health Initiative helped uncover some of those differences. And those studies were funded right here at ORWH and the National Heart, Lung, and Blood Institute (NHLBI).
On its website, the NHLBI outlines some of those differences.i While men usually report chest pain during a heart attack, only half of women do. And women are more likely to report pain in the arms, back, neck, jaw, or stomach. They are more likely to be lightheaded or dizzy. And they are more likely to report indigestion, heartburn, nausea or vomiting, extreme fatigue, or problems breathing.
Actress Rosie O'Donnell did not call for help when she had a heart attack because she did not know that she was having a serious medical emergency. Her story highlights the need to make sure everybody knows the signs and symptoms of heart attack and the need to call 9-1-1 right away.
What we can do
Many members of the public know some of the common signs of heart attacks, but we also need to tell our friends, relatives, and colleagues how the signs may be different for women.
Those of us who are part of the biomedical research enterprise must include both women and men in clinical studies and report the study results by sex. Including both sexes and analyzing for sex differences ensures better patient care for everybody. In fact, considering sex is one step on the way to providing individualized treatments for everybody.
Candace Tingenii, Teresa K. Woodruff, and their colleagues at Northwestern University point out that, in order to translate research into the clinic, education about health differences between men and women must become a regular part of the medical school curriculum. Tingen et al. also made the case for why physicians must receive continuing medical education in this area.
We heartily agree! ORWH has developed a series of courses on sex and gender that offer continuing medical education credit. They are available to anybody at no charge, so please check them out.
Research has already uncovered many sex differences in heart disease, and those efforts continue. For example, Mozzafarian et al.iii cited a study from a Veterans Health Administration cohort of cardiovascular disease (CVD) patients in which women with CVD were less likely to receive statins than men (although the appropriate prescription of cholesterol-lowering medications for men and women at risk for CVD is also an issue).
And Tingen and her colleagues cited findings that physicians were more likely to assign a lower risk category to their female patients with CVD than their male patients with similar symptoms.
So, during American Heart Month, we can reflect on where we've been and where we're going. We continue to encourage researchers to look at sex influences in CVD and in other diseases and conditions. We also encourage researchers, whether clinical or preclinical, to consider sex as an important variable. That way, we can move our research to the bedside more quickly and in a way that will benefit both women and men. And we will continue to inform the public of our important findings through outlets such as our A to Z summary on sex differences in heart attacks and our online courses.
In short, the beat goes on.
iNHLBI. What Are the Signs and Symptoms of Heart Disease? Retrieved February 2016 from http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/signs
iiTingen, C.M., Kim, A.M., Wu, P-H., & Woodruff, T.K. (2010). Sex and sensitivity: the continued need for sex-based biomedical research and implementation. Women's Health, 6(4), 511–516. PMID: 20597615
iiiMozzafarian, D., Benjamin, E.J., Go, A.S., Arnett, D.K., … & Turner, M.B., on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2016). Heart Disease and Stroke Statistics—2016 Update: A Report From the American Heart Association.Circulation, 133. PMID: 26811276