Tracking Outliers: A Mission to Shrink the Gender Gap in Heart Disease | Cardiology Magazine
Profile | Alan Rozanski, MD, FACC, made his career out of studying outliers. He honed in on the values in data sets that were not quite like the others. He studied data points that were markedly different and told the physicians he mentored that those dissimilar values — the ones that seemed to topple studies and made little sense — were the ones that were potentially of most interest.
One of the students he mentored was Noel Bairey Merz, MD, FACC, who came to Cedars-Sinai Medical Center in Los Angeles, CA, as a clinical cardiology fellow in the mid-1980s following residency at the University of California San Francisco. While doing research as a fellow, Bairey Merz began to notice that Rozanski’s passion for studying outliers could be explored even further, and as she delved into the research, it became clear that many of the outliers had one thing chiefly in common: they were typically women.
From there, she took her mentor’s lead and began studying outliers with a focus on women and heart disease. Now, Bairey Merz is an expert on and advocate for women and heart disease, and serves as the Women’s Guild Endowed Chair in Women’s Health, and is a professor of medicine at Cedars-Sinai Medical Center, where she also serves as the director of the Barbra Streisand Women’s Heart Center and the director of the Preventive Cardiac Center. She was principal investigator on the National Heart, Lung and Blood Institute’s Women’s Ischemia Syndrome Evaluation (WISE) study, as well as others including one on the role of gender on outcomes in acute myocardial infarction in patients and another on coronary microvascular disease and endothelial function in women.
Research is at the heart of Bairey Merz’ mission to remove the gender gap in cardiovascular disease. Heart disease is the leading killer of women in the U.S., due in part to the fact that it is poorly understood, says Bairey Merz. In 1991, the late Bernadine P. Healy, MD, FACC, was the first to use the short-story heroine, Yentl — who disguised herself as a man to attend school — as a way to describe the disparity in understanding and treatment of women with heart disease. The so-called “Yentl Syndrome” is alive and well more than two decades later, according to Bairey Merz, who in a 2011 European Heart Journal editorial cited the results of two studies that both “demonstrate adverse gender differences for women whereby stable women have more myocardial infarctions, and women with acute coronary syndrome have higher death rates compared with men.”
“We remain 35 years behind in understanding female pattern heart disease as well as we understand it in males,” she said. “While we have described sex and gender differences, we have important work to do in the area of accurate diagnosis and effective treatment.”
And heart disease does not seem to target women of just one age range. According to Bairey Merz, while death rates from heart disease have fallen in all age groups, it has not done so in those under age 50, and the sobering fact is that more young women die of heart disease than breast cancer. “It is the leading killer of women at all ages,” said Bairey Merz. “This is not acceptable given that heart disease is preventable and treatable.”
But she says there is progress being made. “Awareness among providers and the public that heart disease is the leading killer of women is now above 50 percent,” she said. When she began studying the topic, awareness was below 20 percent. “While this statistic is a gratifying result of the last decade of work, we still have much to do.”
The next step is to ensure women have a personal relationship with their heart — and understand that it is not just a man’s disease. “Less than 10 percent of women believe that heart disease is a threat to their own health,” said Bairey Merz. “Making that personal connection is obviously a necessary piece in the battle to eradicate the disease.”
Bairey Merz takes heart disease personally after years of witnessing first-hand the damage it can do. She steers clear of cigarettes and abides by a heart-healthy, Mediterranean nutrition plan which emphasizes plant-based foods, healthy fats and whole grains. She has made an effort to stay active and maintain a healthy weight as she ages.
However, making a global difference in the knowledge gap about women with heart disease will take even more than her tireless team at the Barbra Streisand Women’s Heart Center tackling the issue. Leading medical professional societies like the ACC must continue to be involved in the continued fight to raise awareness about women and heart disease.
Bairey Merz’ involvement in the ACC began when she became a Fellow of the ACC (FACC) in 1989. She has since used her expertise during her terms as chair of the College’s Prevention of Cardiovascular Disease Committee, member of ACC’s Hypertensive Disease Committee and esteemed member of the ACC Board of Trustees. The ACC itself has programs like the Coalition to Reduce Disparities in Cardiovascular Outcomes — known as credo — which provides cardiologists, nurses and other health care providers who treat or prevent cardiovascular disease with the tools to assure optimal care for their increasingly diverse patients. By developing and disseminating evidence-based educational tools, credo seeks to help clinicians better serve all of their patients, regardless of race, ethnicity, gender, primary language, or other factors that may impact care.
Her advice to those in leadership positions at medical professional societies, hospitals and practices is simple: don’t leave the other half out. “You must include sex and gender in all topics, projects, programs and publications,” Bairey Merz urges.
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