Cardiovascular disease is one of the leading causes of death in women - and the mortality rate has been steadily increasing since 2017 in Canada and the United States.
Monica Parry
That's why Monica Parry, an associate professor at the University of Toronto's Lawrence S. Bloomberg Faculty of Nursing, uses her program of research to raise awareness about women's heart health.
Much of Parry's work is aligned with four of the UN's Sustainable Development Goals - which includes enabling healthy lives and reducing inequalities - in addition to The Lancet commission's target of reducing cardiovascular disease in women around the world by 2030.
"Globally, one woman still dies every 16 minutes of heart disease and many factors affecting women's risk of heart disease are often gender-based," says Parry.
"It is imperative we address the gaps in research and care for women with cardiovascular disease."
Women are more likely to be caregivers, Parry adds, and this can contribute to them delaying seeking care for symptoms or focusing on themselves. Research has also shown that symptoms of heart disease in women manifest differently than in men and may be mistaken for other health conditions.
"Many women are simply unaware of their risk factors or symptoms, and this is further complicated by the fact that most guidelines for heart health and previous clinical trials have been focused on men and men's anatomy," says Parry.
In recognition of heart month and the goal to increase awareness about cardiovascular disease in women, writer Rebecca Biason recently spoke to Parry about how she plans to address gaps in the care and management of women's heart health - and her efforts to empower women to help them manage their disease.
How does gender affect the risk of heart disease in women?
Women have non-traditional risk factors for heart disease - some of these are societal and based on gender and some are biological. Diseases associated with an increased risk of negative heart health such as obesity, diabetes and hypertension affect women differently as do other life events such as pregnancy, where the risks from preeclampsia and eclampsia can heighten a woman's risk of developing chronic heart conditions later in life.
Societally, however, women are often positioned in roles of caregiving or are in lower economic status positions, and that can add to their stress level, further increasing their risk factors. Some of my current research is examining the role of unpaid caregivers and their mental health in Canada, 54 per cent of whom are women. In addition to wanting to gather more data about women who are of diverse ethnic backgrounds, I am also interested in learning more about the intersection of risks, especially for conditions like Takotsubo syndrome, which is a heart condition that can be caused by stress.
How does your work aim to improve cardiovascular health in women?
Self-management of symptoms - especially if women can distinguish them from other chronic conditions - can be lifesaving. With support from the Canadian Institutes of Health Research (CIHR) and an AMS Healthcare Fellowship, I have been working to develop and pilot a web-based app that uses a progressive algorithm and chatbot called "Holly" to screen women for heart-related symptoms. We know women often delay seeking treatment for their symptoms and that can be further complicated if they are unaware of whether their symptoms are related to their cardiovascular condition or not.
Holly asks women a series of questions about their last heart event, which is stored as an event profile. On subsequent logins, Holly asks women for a heart check, a series of questions to determine if they are experiencing acute cardiac symptoms and assigns them a risk profile: green (no risk) yellow (some risk) or red (severe risk), based on their answers. A user is then encouraged to seek further health assessment by her primary care provider or call 911 and go to the ER depending on her risk profile.
Working with our patient partners, we have also uncovered the need to create new body maps as part of the app to help women locate and identify their pain when identifying their symptoms for Holly. Most body maps are based on the male anatomy and in women we found that heart-related pain and discomfort can be found in regions that include the legs, such as in Kounis syndrome, an acute coronary syndrome associated with allergies and hypersensitivity reactions.
Holly also offers a library of resources for women to gain greater knowledge about their condition - another finding that arose as a result of our collaboration with patient partners. Many of the women in our focus groups indicated they wanted to have access to peer-reviewed and well-sourced materials about specific aspects of their heart condition.
How might education of future health-care providers help advance women's heart health?
Awareness and education are key, both for women and for health-care providers. As a nurse practitioner who has worked on the cardiac unit, I have seen first-hand how women recover more poorly or have slower rates of recovery after cardiac surgery. In our education program at Bloomberg Nursing, we are incorporating a focus on symptoms of heart disease in women. I am a co-investigator with the CIHR-funded CANadian Consortium of Clinical Trial TRAINing platform that aims to enhance national clinical research capability and quality into clinical research education and good clinical practice, and also a co-principal investigator with the CIHR-funded training program titled "Maximize Your Research on Obesity and Diabetes" (myROaD), a national training platform aimed to train the next generation of researchers in obesity, diabetes and cardiometabolic health. Both training programs focus on the intersections of sex, gender, race and ethnicity.
My PhD students at Bloomberg Nursing are all focused on addressing aspects of heart disease in women - from young South Asian women with low physical activity and increased heart health risk to understanding the intersections of race and gender in Black Canadian women who have had a hypertensive disorder of pregnancy. Through their work we will continue to bring a diverse perspective and awareness to cardiovascular disease in women and move this research into the future.
