Cardiovascular disease (CVD) is the leading cause of death for both men and women, yet disparities in the cardiovascular health of women still loom over our society. In yesterday’s plenary session, “Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care,” Dr. Nanette Wenger, MD, outlined the shortcomings of the current state of women’s cardiovascular health and challenged providers and the laboratory medicine community with a call to action to provide equitable care.
Wenger, a pioneer in women’s cardiovascular health, has had an illustrious career spanning over 60 years. She was the first female chief resident in cardiology at Mt. Sinai Hospital in New York and among the first female graduates of Harvard Medical School. She also founded the Women’s Health Center at Emory University. Wenger worked to improve healthcare for women and minorities in underserved patient populations at Grady Memorial Hospital in Atlanta, one of the largest safety-net hospitals in the United States.
Publishing over 1,700 scientific articles, she contributed substantially to the field of cardiology, for which she has been highly decorated by several cardiology societies, and she continues to advocate for awareness and improvements in women’s cardiovascular care.
“When I was in medical school, I was taught that heart disease was a man’s disease,” Wenger said. Only in the last few decades have healthcare providers recognized sex-specific differences in symptoms, pathobiology, and therapeutic response. While these realizations spurred efforts to spread awareness, Wenger remains unsatisfied. “The attention has not been enough,” she said.
While U.S. awareness campaigns, such as Wear Red, have been moderately successful, that progress was lost over the last decade, according to Wenger. She referenced a 2019 survey in which the majority of women were unable to identify the signs and symptoms of a heart attack.
The awareness problem extends to healthcare providers as well. Only 20% of medical students report receiving sex-based cardiovascular biology education, and the vast majority of primary practice clinicians report not being comfortable treating CVD in women, as do half of cardiologists.
Wenger’s goal is to remedy these disparities and achieve equity in healthcare access and quality. She demonstrated that this can be effective with focused effort. Due to efforts in the early 2000s, the number of cardiovascular disease deaths in women dropped below that of men in 2014 and has remained there since. In this case, Wenger said she is “delighted to be in second place and we want to stay there.”
The session centered on the need for a cultural shift in the way CVD data is presented both to professionals and women. She argued that white men should not be the gold standard and that “atypical” women-specific cardiovascular symptoms are not atypical for over half of the world’s population. Increased awareness of CVD in women would also benefit men, she added, particularly with better recognition of cardiovascular events associated with microvascular blockage.
Wenger concluded with a call to action directed at the entire healthcare community. She stressed the need for culturally sensitive awareness campaigns that emphasize prevention, the development of new risk calculators that include women-specific factors, and increased advocacy for research on CVD and stroke prevention and treatment. To optimize cardiovascular health, we must engage communities and advocate for public policy that provides healthy food access and safe spaces for physical activity.
Women and minorities are “understudied, under treated, and it is our shame”, said Wenger. “[We must] provide equal access and equal to care to everyone in these United States.”