We know a lot about heart disease among middle-aged men – but what about women?
Both male mice and men are overrepresented in Danish cardiovascular research. This means that our knowledge and opportunities for treatment of women are poor compared to men.
When men and women go to the doctor’s office with chest pain, the diagnoses of men are often more accurate than those of women and for a very simple reason: research in cardiovascular disease is to a large extent conducted on male subjects rather than on females.
“For many years, research in cardiovascular disease has focused on arteriosclerosis and arterial thrombosis, both examples of cardiovascular disease that primarily hit men, whilst we have overlooked the disease that primarily hit women,” says Eva Prescott, professor at the University of Copenhagen and leader of the Center for Cardiovascular Research at Bispebjerg-Frederiksberg Hospital.
She continues to explain that chest pain in women often results from other aspects than arteriosclerosis, such as ‘broken heart syndrome’, where a sudden storm of stress hormones causes chest pain and heart failure, or spontaneous coronary artery dissection, where the coronary arteries are obstructed. Both conditions may present themselves as arterial thrombosis, but they have a completely different cause, and they strike women in 90% of all instances. We have not conducted enough research in these types of disease, and consequently, treatments are not very targeted.
Researchers prefer male mice
Challenges with knowledge on male and female disease already begins when researchers select mice for testing.
Janne Lebeck, Associate Professor at Aarhus University, does research in obesity and diabetes, both forerunners for cardiovascular disease. She explains that “when molecular correlations are investigated, researchers often prefer male mice to female to avoid taking cyclical changes into consideration”.
High numbers of male subjects in clinical studies
Previously, only male subjects were chosen in studies with humans. Today, it is standard procedure to include women, although there is still a majority of male subjects in these types of studies.
“We know a lot about the diseases that hit white middle-aged men. Knowledge by which we base treatments on all races and sexes – also when it comes to dosing of medicine. Consequently, women do not always receive the proper treatment,” says Eva Prescott, University of Copenhagen.
Research must take both men and women into consideration
Eva Prescott and Janne Lebeck are on a mission to make researchers aware of this issue. Sex specific patterns are significant factors to be aware of within research. In September 2022, they organized a course with the aim of making younger researchers aware of the importance of considering sex in research. Hopefully, we will see a sex-specific and targeted treatment of patients in the future.
The course was called Sex Differences in Metabolic and Cardiovascular Disease and was held from 14th-16th of September 2022 in Sønderborg. It was organized by the Danish Cardiovascular Academy, Danish Diabetes Academy and Danish Data Science Academy.