Heart Disease in Women: Formulating Research Questions

The Challenge

Ischemic heart disease (IHD) is the number one killer of U.S. and European women (WHO, 2008). Nonetheless heart disease has been defined as primarily a male disease, and “evidence-based” clinical standards have been created based on male pathophysiology and outcomes. As a result, women are often mis- and under-diagnosed (Regitz-Zagrosek, 2011; Taylor et al., 2011).

Method: Formulating Research Questions

Improving women's healthcare has required scientific and technical breakthroughs; it has also required new social, medical, and political judgments about women's social worth, and a new willingness to support women's health and well-being. Analyzing sex and gender in heart disease has required formulating new research questions about disease definitions, symptoms, diagnosis, prevention strategies, and treatments. Once sex and gender were factored into the equation, knowledge about heart disease increased dramatically. As is often the case, including women subjects—of diverse social and ethnic backgrounds—in research has led to a better understanding of disease in both women and men.

Gendered Innovations:

Research on heart disease offers one of the most developed examples of gendered innovations. From the expanding literature on sex and gender analysis in this area, we highlight several key developments:

  1. Redefining the pathophysiology of IHD. Analyzing sex in clinical research has led to an understanding that heart disease in women often has a different pathophysiology than in men—particularly in younger adults.
  2. New diagnostic techniques—some still experimental—are more effective than angiography for understanding the causes of IHD in women with chest pain in the absence of obstructive coronary artery disease (CAD).
  3. Understanding sex differences in symptoms has led to earlier and better diagnosis of IHD in women.
  4. Rethinking the estrogen hypothesis in light of large-scale trials of menopausal hormone therapy has challenged the (oversimplified) concept of a cardioprotective effect of estrogens.
  5. Gender analysis in risk factors and prevention reveals that smoking has historically been far more common among men than women; however, in some countries, such as Sweden and Iceland, smoking rates are now higher among women (Shafey et al., 2009). The harmful effects of tobacco smoke on atherosclerosis are greater in women than in men (Tremoli et al., 2010).