Celebrating Progress and Carrying the Torch:
Black History, Heart Health, and Trailblazing Women in STEMM
By Dr. Janine A. Clayton
February may be the shortest month of the year, but it brings no shortage of opportunities to celebrate achievement and progress—and to strengthen resolve advance equity. This month, we observe Black History Month and American Heart Month, as well as National Black Women Physicians Day, National Women Physicians Day, and the International Day of Women and Girls in Science.
Celebrating and Uplifting Black Women in Science
Throughout history, Black women have blazed trails across the fields of science, technology, engineering, mathematics, and medicine (STEMM). As an ophthalmologist myself, I am grateful for the contributions of women such as Dr. Patricia E. Bath. Among her many accomplishments, Dr. Bath was the first woman to direct an ophthalmology residency program in the United States. She was also the inventor of the laserphaco probe—a surgical tool used to remove cataracts—and the first Black woman physician to receive a patent for a medical invention. Dr. Bath’s passion for the prevention and treatment of blindness stemmed from her time as an intern at Harlem Hospital and an ophthalmology fellow at Columbia University, where she observed drastic differences in the blindness rates between Black and White people because of inequitable access to ophthalmic care.[1] These observations led her to study these racial disparities in greater depth and establish a now globally practiced discipline known as community ophthalmology.
Dr. Josephine Isabel-Jones, FACC, is another notable Black woman physician. After bravely declaring her dream to become a pediatrician as an 8-year-old growing up in the segregated South in the 1940s, she became the first Black woman in the United States to be board-certified in pediatric cardiology.[2] Dr. Isabel-Jones led a storied career as a part of the faculty at the University of California, Los Angeles (UCLA), where she held numerous positions, ranging from the Director of the Echocardiography Lab to the Assistant Dean of Student Affairs. In fact, Dr. Isabel-Jones’ commitment to diversity in STEMM led her to help reshape the processes by which UCLA medical school candidates are selected for admission. Now Professor Emeritus of Pediatrics, Dr. Isabel-Jones continues advocating for and mentoring the next generation of Black women aspiring to careers in pediatric cardiology.
Though there is still much work to be done, I am proud of the breadth and depth of efforts that NIH is undertaking to promote equity, diversity, and inclusion in the biomedical workforce. I encourage you to learn more about ORWH career development programs and projects on the ORWH website, including the Women of Color Research Network, and share these resources with students and colleagues.
Reducing Disparities and Advancing Equitable Health Outcomes
Reducing health disparities among Black women is critical to ORWH’s mission to advance the health of all women. For example, as I shared in my April 2022 Director’s message, we still have a long way to go to fully understand why maternal health is poorest for women of color, including Black women, despite medicine’s being the best it has ever been. Black women who are pregnant are at higher risk for cardiovascular-related health problems compared with White pregnant women. Research supported by the National Center for Advancing Translational Sciences (NCATS), the National Institute of Neurological Disorders and Stroke, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) shows that Black pregnant women are at significantly higher risk for chronic hypertension (i.e., high blood pressure), pregnancy-induced hypertension, and stroke during delivery compared with non-Hispanic White women.
Much is being done across NIH and the research community to close these and other gaps. For example, the NIH Implementing a Maternal health and PRegnancy Outcomes Vision for Everyone (IMPROVE) initiative continues to fund research to reduce racial, ethnic, and socioeconomic disparities in maternal health outcomes. This initiative is led by NICHD, ORWH, and the National Institute of Nursing Research, with participation from multiple other NIH Institutes, Centers, and Offices (ICOs). Along with our colleagues, we are proud to be co-hosting the 2023 IMPROVE Awardee Workshop next month to share recent research results and progress. Learn more about the workshop and IMPROVE on the NIH Maternal Morbidity and Mortality Web Portal.
Additionally, initiatives such as the All of Us Research Program, supported by ORWH and other ICOs, aim to improve the health of Black people—and all people—by creating more diversity in both research and data. All of Us is special because about 80% of the data available to researchers are contributed by participants from historically underrepresented communities in research, including people from underserved racial and ethnic groups, people from sexual and gender minority groups, and people living in rural areas. Diversity of both participants and researchers is essential to strengthening research findings and advancing scientific discoveries. Recently, All of Us announced new research funding opportunities to expand use of its data.
Advancing Research to Improve Women’s Cardiovascular Health Outcomes
In addition to the above disparities in heart and maternal health outcomes among women of color, coronary heart disease remains the leading cause of death among all women in the United States,[3] despite advancements in both prevention and treatment that have led to an overall decline in mortality over the past few decades. In fact, among women ages 20 or older, about 1 in 16 have coronary heart disease, which is the most common type of heart disease. Keeping #OurHearts healthy is important for all women across the lifespan. This year’s American Heart Month campaign from the National Heart, Lung, and Blood Institute (NHLBI) reminds us that “self-care is heart-health care,” which is a timely nudge in light of the increased stress many of us have faced over the past 3 years as we have navigated the COVID-19 pandemic.
“Cardiovascular disease” (CVD) is the umbrella term for diseases affecting the heart or blood vessels. CVD is often underdiagnosed or misdiagnosed among women because of many inequities that exist at both the individual and the institutional levels. Last year, I co-authored an article for the Journal of the American College of Cardiology regarding one of these institutional inequities: the failure to address sex and gender as key variables in CVD-related research. Sex and gender influence all aspects of our heart health, from prevention of disease to treatment response. Considering these variables across the biomedical research continuum will help improve heart health outcomes for all women. I encourage you to read the article’s abstract and to visit our Sex & Gender webpage to learn more and to access additional educational resources.
Strengthening Research to Better Understand How Sleep Disturbances and Menopause Affect Heart Health
Fortunately, there are many ways to prevent CVD, starting with understanding your risk, choosing healthful foods and drinks, maintaining a healthy weight, exercising regularly, and refraining from use of tobacco products. Reducing stress and improving sleep are also critical. The health impacts of poor sleep and CVD are well known, but the pathways linking sleep and negative cardiovascular outcomes are not well understood, especially among women. In 2018, NHLBI partnered with ORWH and the U.S. Department of Health and Human Services Office on Women’s Health on the Research Conference on Sleep and the Health of Women to share knowledge and promote research on women’s sleep health and CVD. As a result of the conference, an article was published in the Journal of Women’s Health describing the current state of research on sleep disturbances and CVD among women and the future research needed.
Additionally, research supported by NHLBI and NCATS published in the Journal of the American College of Cardiology examines sleep irregularity and the risk of adverse cardiovascular events. Researchers analyzed data from the Multi-Ethnic Study of Atherosclerosis—a diverse, community-based, NHLBI-sponsored medical research study—and discovered that participants with the most irregular sleep duration or timing had more than double the risk of having a CVD-related event over 5 years of follow-up compared with those with the most regular sleep patterns.[4] These findings suggest that irregular sleep patterns may be a new pathway to understanding CVD and its risks. This is compelling because sleep is a modifiable lifestyle factor that many people are able to change to promote better cardiovascular health outcomes. NHLBI offers a host of science-based information to improve sleep, including Your Guide to Healthy Sleep.
Another under-researched area is how menopause affects the cardiovascular health of women. The menopause transition is a distinct part of every biological woman’s life, yet little is known about how the menopause transition affects women’s body composition and cardiometabolic health. Wendy Kohrt, Ph.D., is funded by one of ORWH’s signature programs, the Specialized Centers of Research Excellence on Sex Differences (SCORE), at the University of Colorado Anschutz Medical Campus and conducts research on how the menopause transition affects women’s health. A recent article published in Obesity by Dr. Kohrt and her colleagues provides an excellent overview on how menopause affects the health of women, as well as beneficial lifestyle interventions to mitigate the negative impacts of menopause, and the importance of including women who are in the menopause transition in research studies to represent women across the lifespan.
To promote research and dialogue on this and related topics, menopause will be the focus of the 7th Annual Vivian W. Pinn Symposium on May 16, 2023. This annual symposium honors another trailblazing woman in science and medicine, the first Director of ORWH, Dr. Vivian W. Pinn. Please save the date for this exciting event and check the ORWH website for updates.
Additional Heart Health Resources
On February 3, NHLBI hosted the National Wear Red Day®: Get #OurHearts Pumping! event, which featured 25 minutes of heart-pumping activity led by the NIH Fitness Center. As the name implies, National Wear Red Day is a national effort, and as you can see from this year’s photo, ORWH staff members showed full support. On February 17, NHLBI also hosted a Facebook Live event, Getting to Know #OurHearts, which was a conversation with experts to help Americans improve their heart health literacy and promote understanding of how to live a heart-healthy lifestyle. I encourage you to watch the videocast to get “heart-smart.”
Because February is American Heart Month, there is a special emphasis on heart health this month, but NHLBI offers several resources to help you learn more about heart health all year long, including heart health and pregnancy resources to help people understand risk factors for pregnancy-related heart problems. In addition to these resources, the Centers for Disease Control and Prevention offers the Well-Integrated Screening and Evaluation for WOMen Across the Nation (WISEWOMAN) program. WISEWOMAN helps women understand and reduce their risk for heart disease and stroke by providing services to promote lasting heart-healthy lifestyles. I also encourage you to listen to the Association of Black Cardiologists’ recent series with Medical Alley focusing on race and cardiovascular disease in the U.S., including discussions on maternal health.
Staying the Course
Taking time to reflect on progress while continuing to drive change is essential—whether related to women’s health or their careers. I look forward to advancing ORWH’s work to address the disparities that exist across the lifespan and career span of all women, including those specific to Black women, in 2023. I wish each of you a healthy American Heart Month and Black History Month.
References
Patricia Bath. Massachusetts Institute of Technology. (n.d.). Retrieved February 15, 2023, from https://lemelson.mit.edu/resources/patricia-bath
Ansong, A. K. (2021, August 19). Feature: Leading with grace: The story of Dr. Josephine Isabel-Jones. American College of Cardiology. Retrieved February 15, 2023, from https://www.acc.org/Latest-in-Cardiology/Articles/2021/08/01/12/42/Feature-Leading-With-Grace-The-Story-of-Dr-Josephine-Isabel-Jones
Centers for Disease Control and Prevention. (2022, October 14). Women and heart disease. Retrieved February 15, 2023, from https://www.cdc.gov/heartdisease/women.htm
Huang, T., Mariani, S., & Redline, S. (2020, March 2). Sleep Irregularity and Risk of Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Journal of the American College of Cardiology. Retrieved February 27, 2023, from https://www.sciencedirect.com/science/article/pii/S0735109720301625?via%3Dihub