For decades, cardiovascular research studied men and assumed women’s hearts worked the same way. New Hyde Park, N.Y.-based Northwell Health is working to change that.
Many issues in women’s heart health have been overlooked due to assuming women’s symptoms looked like men’s. For example, a TIMI IIIB trial that had about one-third of participants as women found that 25% of women with myocardial infarctions had no obstructive lesions. Women, on average, have strokes at a lower systolic blood pressure than men.
“The question shouldn’t be ‘Does sex matter?’ It should be ‘How does sex matter?'” Stacey Rosen, MD, executive director of Northwell’s Katz Institute for Women’s Health and senior vice president of women’s health at the system, said in a session of the Northwell Cardiovascular Summit on Oct. 1. “Whatever you do foundationally, I need you to ask: How is this different between the sexes?”
Northwell is looking to use tools in its Epic EHR to make it easier for clinicians to tailor care for women, Dr. Rosen said. It’s also making changes to how it identifies cardiovascular risk. The system is evaluating breast arterial calcification, found on routine mammograms, as a cardiovascular risk enhancer for women.
“It’s free. It’s part of a woman’s mammogram. We ignored it for years,” Dr. Rosen said. Northwell has reported the finding on 100,000 mammograms.
Dr. Rosen said open questions remain, including whether hypertension treatment needs sex-specific cutoffs. The system is also focusing more on bringing women into clinical trials. A system survey of 500 women asked why they don’t join trials and the top answer was they were not asked to.
The need for better cardiovascular care for women comes amid challenges, such as high maternal mortality, and women deferring their own care.
“Every mother, every sister, every girlfriend is a lioness for the family, but cancels her own appointments,” Dr. Rosen said.
Dr. Rosen said she is optimistic AI could help researchers reanalyze data from past large trials to learn more about women.
“RCTs will always be the gold standard, but some of the things we’re looking for will take bazillions of dollars, decades, and healthcare needs to move faster than that,” she said.
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