The cultural biases that imperil women with heart disease are so ingrained that a woman’s chance of surviving a heart attack can depend on the sex of her physician. And in general, a woman who has a heart attack is more likely than a man to die.
As two women in the vanguard of heart research, we’ve fought our entire careers to save women from heart disease — their No. 1 killer. In this male-dominated field, progress has been unacceptably slow. But now, we have a new weapon for winning the battle: strength in numbers at the highest level in Washington.
With more than 100 women serving in this historic 116th U.S. Congress, it is time for action and meaningful change. Many of the new women leaders came to Congress to make progress through bipartisan collaboration. We appeal to them to lead us toward curing women’s heart disease, a goal that is achievable in our lifetimes if we put women at the center of our national heart disease research agenda.
That might seem an injustice for men, but for too long the scales have been tipped their way — from drug trials to basic research on mice and cells. The United States will continue to lose 400,000 women each year and watch heart disease deaths rise among young women, while it declines in young men, unless we right the wrongs of the past.
We’ve made incremental changes over the past 25 years with the goal of “including” women in research that too often was designed with male bodies and behaviors in mind. For decades, diagnostic tools and treatments were centered and tested on men. Congress, the National Institutes of Health, the Food and Drug Administration and the Department of Defense have taken steps to get researchers to include women in clinical trials, investigate sex differences and study female mice and cells. But policy alone has failed us; it must be enforced. Reviews of drug trials and recent studies and surveys of scientists conclude we haven’t advanced enough. In 2019, a woman diagnosed with cardiovascular disease will be more likely than a man to do poorly: to live with disability, not get the right treatment, be readmitted to the hospital or become depressed.
To fill critical gaps in our knowledge, the research we need most is related to the reasons women were excluded from trials. Women’s reproductive health and hormonal changes over a lifetime are deeply relevant to their future heart health. This phenomenon is increasingly acknowledged, poorly understood and rarely studied. We must study this connection because the pregnancy-related conditions of gestational diabetes, hypertension and preeclampsia predict future risk of heart disease and stroke. We must also uncover why racial, ethnic and socioeconomic differences in women’s heart disease exist; nearly half of black women older than 20 have heart disease.
Not only do we need women-centered research, we need to better educate physicians on women’s heart health. Only 22 percent of primary care physicians and 42 percent of cardiologists say they are extremely well prepared to assess a woman’s risk of getting cardiovascular disease. And we need to make sure every person in America can recognize and respond to the different symptoms of a heart attack for women. When we asked women nationwide whether they know heart disease and heart attack symptoms, 8 in 10 knew about chest pain. Far fewer were aware of symptoms many women are likely to have, such as fatigue, jaw pain, nausea and anxiety. And many female patients internalize society’s devaluing of their lives and health — to the point that when a woman suspects she is suffering a heart attack, her first instinct will likely not be to call 9-1-1.
There are so many pieces to this puzzle it’s tempting to accept small steps that merely move in the right direction. But with so many women in Congress, we have fresh optimism that a sea change is possible; we must shine a light on this dramatic health crisis. To save women’s lives and decrease the economic burden associated with women’s heart disease, our legislators must unleash every tool in their arsenal to find a cure.
By doing so, they’ll set a powerful example of prioritizing women’s health and lives. Future generations will look back at 2019 as the year we decided to make ending heart disease a reality — for all Americans.
Holly Andersen, M.D., is medical advisor to the Women’s Heart Alliance, which advocates for equity in heart disease research and practice. She directs education and outreach at the Ronald O. Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center in New York. Noel Bairey Merz, M.D., the Women’s Heart Alliance’s scientific advisor, directs the Barbra Streisand Women’s Heart Center at Cedars-Sinai’s Smidt Heart Institute in Los Angeles. She leads the WISE Study, a groundbreaking National Heart, Lung, and Blood Institute–sponsored investigation into women’s heart disease.