Understanding sex differences when it comes to cardiovascular disease will save lives.
Cardiovascular disease (CVD) is the leading killer of women worldwide. But most research, and the clinical evidence for treatment, is based on studies of men. That’s a problem, since it turns out that women have very different treatment responses and disease progression of CVD than men.
Dr. Tara Sedlak, a research scientist with the Vancouver Coastal Health Research Institute, says better research is crucial—especially in Canada where women have higher rates of CVD and mortality. Dr. Sedlak is hard at work conducting multiple studies and reviews, playing catch-up to determine better predictors, better prevention and better treatment for women with CVD.
Dr. Sedlak says there’s a persistent misperception that CVD is a men’s disease, and that impacts care for women. “A few years ago we did a study on angiograms—a standard test for artery blockage—and found that females were getting significantly less angiograms than males. It was a big tip off for us.”
But giving women with chest pain more access to standard testing may not solve the problem either. Studies by Dr. Sedlak and others find standard testing can miss women-specific indicators.
“Women’s CVD is often not as easy to detect as men’s. Many women may present with chest pain but the standard tests don’t pick up anything and they are sent home without an accurate diagnosis.”
Dr. Sedlak says up to 30 percent of women with chest pain or angina do not have the typical male pattern of disease (large artery plaque rupture, cholesterol blockage) that can be seen on an angiogram. Instead, these women have micro-vascular disease (disease of the small blood vessels) that angiograms can’t see.
Microvascular heart disease has since become a special study interest of Dr. Sedlak. The catch is, testing for it—with a special camera threaded into arteries— is expensive and invasive. With donor funding, Dr. Sedlak has been able to test some women in the Women’s Heart Health Clinic at VGH. She’s also applied for grants to fund a larger study of microvascular disease in women. “We have to find a way to test more patients with this hard-to-find predictor. They often have high rates of ongoing chest pain and emergency room visits with poor quality of life.”
Dr. Sedlak has just received a $30,000 grant for a pilot project to improve the accuracy of predicting CVD for women across BC. The grant comes from the Cardiology Academic Practice Plan at UBC, where Dr. Sedlak is a Clinical Assistant Professor in the Department of Medicine. The project will get doctors to fill out a more detailed predictor questionnaire than they currently use. Women and men will be followed up with cardiac CT and angiograms to differentiate accurate sex-specific predictors.
New risk factors, new approach
Dr. Sedlak says a soon-to-be published review of the latest research on sex differences and risk factors for CVD—done with her colleague Dr. Karin Humphries—shows how paying attention to more female-specific criteria could save lives. “Even within the common risk factors—like smoking and diabetes—there are huge differences between the sexes. For example, young female smokers are far more likely to develop CVD than their male counterparts.”
The review article, which will be published in Frontiers of Neuroendocrinology, also highlights predictors unique to women. “Pregnancy is a clear example,” says Dr. Sedlak. “If a pregnant woman has pre-eclampsia or gestational diabetes those are clear signals of vascular problems that we need to pay more attention to. They are pointing to a higher risk of CVD later in life.”
The review article also shows how psychosocial predictors – like stress, anxiety and depression—are all stronger predictors of CVD for women than for men. Depression is a notable new risk factor since it is twice as common in women.
Dr. Sedlak says yet another important risk area for women is the strong link between CVD and conditions like rheumatoid arthritis and lupus. “These conditions present a huge risk factor for women—a two to three-fold increase of CVD in most cases.” Dr. Sedlak is now running a study to better understand the relationship between these diseases and CVD in women.
With the pace of research picking up, Dr. Sedlak is optimistic about the future of heart health for women.
“We are making progress. Women are more aware of heart disease now. And if we can get more women and their doctors to pay attention to these newly recognized risk factors we will definitely improve outcomes.”