WomenHeart: the National Coalition for Women with Heart Disease and theSociety for Women’s Health Research (SWHR) have released a new report identifying the top 10 unanswered questions in the prevention, diagnosis, and treatment of heart disease in women .
The new 10Q Report follows up on a 2006 alert, published because experts felt little traction was being gained in improving the health of women with cardiovascular disease and those at risk for cardiovascular disease. The 2011 report is a scheduled update to the 2006 document, part of a sustained effort to emphasize clinical and research questions where there is still little known.
“We took a group of experts, everyone from clinical care and prevention to basic science and research, to identify the unanswered questions that affect a large number of women, where answering these questions would have a large impact on the health of women or where there are large gaps in knowledge,” Dr Sharonne Hayes(Mayo Clinic, Rochester, MN), one of the lead authors of the new report, told heartwire . “In some cases, it’s a small amount of knowledge, but if we get that information, it would affect millions of women. In other cases, the knowledge is more specific, but it’s an important first step, where if we don’t get it, we won’t be able to move forward. Overall, the range of questions is quite wide, ranging from basic epidemiology to sex-based research.”
The report is intended as a road map for future research in women’s cardiovascular health and is meant to improve early detection, diagnoses, and treatment for women with or at risk of cardiovascular disease.
Disparities in Cardiovascular Disease
Specifically, the 10Q Report asks what factors influence or explain the disparities in cardiovascular-disease epidemiology and outcomes between men and women and what might be the best strategies to assess, modify, and prevent heart disease in women. In addition, the experts question the most accurate and effective ways to recognize chest pain and other symptoms suggestive of coronary heart disease in women.
The expert panel also delves into the role of reproductive history and menopausal hormone-replacement therapy in the development of heart disease, as well as the risk factors associated with pregnancy. Other areas of interest include understanding the best method for studying sex differences in vascular injury, the most effective treatments for diastolic heart failure, and understanding why women are more likely than men to die after MI or surgical revascularization. In addition, understanding psychosocial factors affecting cardiovascular disease in women, as well as the biological variables most affecting the clinical outcomes of heart disease in women, are important research questions, say the experts.
“If you ask what is going to affect the most people, I think the broad questions about understanding the biological sex differences between men and women, which will require biological research at the basic-science level and genetic understanding, is important,” said Hayes. “If we can understand that, it will help both men and women in terms of treatment and care.”
From a population-health perspective, Hayes said that if clinicians and researchers are better able to predict who will get heart disease, this will have a very large impact.
“Our risk-prediction tools are not particularly good for men or women,” she said. “Framingham and theReynolds Risk Score help and are great at the population level, but they’re not really that good for the individual woman sitting in your office when you’re trying to decide how to aggressively manage her risk or when you’re trying to predict if she’ll get heart disease. If we had some biological marker, some better tool or an algorithm, it would make a big difference.”
Pregnant Women and Heart Disease
The 10Q Report also shines a light on an emerging group of patients–pregnant women with high cholesterol levels and blood pressure or those with hyperglycemia, as well as those women who fail a first stress test. Not only is the woman at risk, but there is growing evidence that a developing fetus exposed to this environment–above and beyond genetics–will now be at later risk for cardiovascular disease, said Hayes. There also remain issues regarding pregnant women or women of child-bearing age being excluded from clinical trials.
“We don’t even know how to do [cardiopulmonary resuscitation] CPR on a late-stage pregnant woman,” Hayes told heartwire .
The new report, in its collaboration between WomenHeart and SWHR, is intended for researchers and scientists, helping direct them to use limited resources in areas where there is clinical and research need, as well as for policy makers who fund, guide, and direct health policy.
“We recognize that in the current environment that we’re not going to get huge new funds coming into the [National Institutes of Health] NIH,” said Hayes. “But heart disease is the number-one killer of men and women, so by using the NIH funding to target and answer some of these questions, I think we can get a big bang for our buck.”
Reported by medscape.
J. Kyle Mathews, MD