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Women. (Or lack thereof).

  • Writer: digitalflynn
    digitalflynn
  • Jul 1, 2021
  • 7 min read

Updated: Jul 8, 2021

"When we exclude half of humanity from the production of knowledge we lose out on potentially transformative insight." ~ Caroline Criado Perez


(Warning, this post is full of tangents.)


Back in February 2019, I attended a talk titled "Broken Heart Syndrome: The Science of a Broken Heart", presented by Dr Nelson Chong (Senior Lecturer at Nottingham Trent Uni). My interest in the talk had nothing to do with personal heartbreak (chocolate is always the answer, obviously), but more out of general interest in cardiology. Some things I learnt from the talk: 1. Broken heart syndrome is a real condition (scientifically known as Takotsubo cardiomyopathy). It is thought to be caused by an excessive release of stress hormones, usually triggered by a painful event, such as a bereavement. It can be reversible, but in worst cases it's fatal. 2. Heart attack symptoms present themselves very differently in women, compared to men. 3. The endocrine system may play a part in increased risk in heart attacks in women. 4. There is not enough research done on women and cardiovascular health, or women and health in general.


Thus spawned my new interest in women's health and further anger at women's inequality.


(Before going off on my spiel of how women aren't represented in science research enough, you can read more about Nelson's (very interesting) talk here.)


Cardiac function lies under the control of the autonomic nervous system. This falls into two separate systems: the parasympathetic system (rest and digest) and the sympathetic nervous system (fight or flight). This isn't a post about the physiology of the NS (maybe another time...), but it's relationship with the cardiovascular system should be quite apparent - when we're stressed, our heart beats faster and potentially causes an increase in blood pressure, (depending how our bodies respond to stress). In films, when we see (mainly men) having heart attacks, they occur fairly suddenly, almost dramatically. This makes it easy to recognise that something serious is happening (both in real life, as well as on screen). In women however, the symptoms are a bit more subtle. In a US study of >500 women with an average age of 66, the most common preliminary heart attack symptoms reported were unusual fatigue, sleep disturbance, shortness of breath, indigestion and anxiety. Only 30% reported chest pain or discomfort before an attack. This makes it very difficult to diagnose, or even predict whether a women is going to have a heart attack in the near future, as the aforementioned symptoms can be attributed to a multitude of other health issues. This results in women being sent away from their GPs with an irrelevant prescription, or a leaflet on how to sleep better. Cardiovascular disease, (in particular coronary heart disease and stroke) is the biggest killer of women across the world. It claims more women's lives than all forms of cancer combined. (Garcia et al, 2016; Gordon et al, 2015; Woodward, 2019; Sharma and Wood, 2018).


News to me!


Heart attacks are most common in women >65 years old. What happens around this time? Women are post-menopausal from around (the average age of) 51 years old. Menopause needs a separate post altogether, but women experience a significant drop in oestrogen. Oestrogen is cardio-protective - it helps modulate vascular function by targeting both endothelial and vascular smooth muscle cells. This leads to the release of prostacyclin and nitric oxide - both vasodilators, so they enhance blood flow and therefore oxygen and nutrient delivery. Additionally, oestrogen also reduces the production of angiotensin II and and endothelia, which are vasoconstrictive. So as we age we start to lose these protective benefits and our risk of CVD is significantly higher (Newson, 2018; Thurston et al, 2017).


What else is more common in women than men over 65 years? Alzheimer's disease. Oestrogen is also neuro-protective. Sadly, there is still some unawareness amongst health practitioners of the role the endocrine system plays in CVD and cognitive decline in peri-menopausal and post-menopausal women. As if we didn't need to face enough problems with ageing...


It was apparent from Nelson's talk that not only is there not enough research being done on women, but there are not enough women carrying out research. In the book Invisible Women, by Caroline Criado Perez, she exposes the data bias towards men and how gender bias has existed all throughout medical history (See chapter: Going to the doctor). Women made up only 25% of participants in trials for congestive heart failure in studies from the late 1980's-2012. Considering researchers have discovered that there are sex differences in every tissue and organ system in the human body, applying the results of predominantly male-based studies to female patients are perhaps going to be ineffectual. Differences between the sexes means that treating everything from cancer to diabetes needs to be sex-specified, yet research rarely acknowledges this. (Arnetz et al, 2014; Rinn et al, 2004; Karp et al, 2017; Keitt, 2004) Can sound medical advice exist for women if there's a lack of sex-disaggregated data?*


Historically, as most research has been done on men, it means more current research will continue to be done on men to produce comparable data. This is still used as an excuse to exclude women from research today. On a positive note, attempts have been made to ensure researchers are properly representing females in medical research. It has actually been illegal not include women in federally funded clinical trials since the US passed the National Institute of Health Revitalisation Act in 1993. (Although unfortunately a review of this in 2000 revealed little improvement, with fewer women still being included in studies. I've not been able to find any updated reviews yet..) Similar enforcements have been made in the main funding bodies of Australia and Europe. In the past decade, the German Society of Epidemiology has insisted on researchers giving justification when deciding only to use one sex in a study where the results may affect both sexes, with the Canadian Institutes of Health following suit. We're still waiting for something similar to be enforced in the UK...


"It's not always easy to convince someone a need exists, if they don't have that need themselves." ~ Caroline Criado Perez. (I'd recommend the book Invisible Women.)



In the mean time, for women to look after their cardiovascular, neurological and overall health: diet and exercise is undoubtedly a good place to start. Following a diet such as the Mediterranean Diet - high in fresh fruit, vegetables, whole grains, nuts, seeds, oily fish and low fat dairy products has proven benefits to overall health. Try and partake in aerobic activities (dancing, swimming, running etc) and weights (pilates, weight lifting, calisthenics) as often as you possibly can each week. It's important to communicate any concerns with your GP and if you are menopausal you can request to see a specialist who will guide you on the best way to manage your symptoms. Some websites that may help are The Menopause Charity , With Alva, My Menopause Doctor


And finally, the US charity Go Red For Women is helping to spread awareness of women's heart health. The site offers lifestyle advice aimed at women's cardio and all round health protection and is worth taking a look if you'd like to educate yourself further on the topic.


And if you'd like to know more about women's brain health, this Ted Talk by Lisa Mosconi is well worth a watch.


I know this isn't the only area where inequality lets women down. If you work in a field where you think there is a significant gender gap, get in touch to let me know your thoughts on the matter. rosie@stemandpoise.com


*That's a rhetorical question.




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