When Disease Strikes, Gender Matters
Experts in Harvard Chan School discussion say research, treatment need to be more sensitive to differences between men and women.
Much of how we attack serious illnesses like heart disease, depression, and Alzheimer’s has been informed by studies of men. And that approach misses important gender differences in how the diseases look, progress, and respond to treatment, according to panelists at the Harvard T.H. Chan School of Public Health.
“[We need] education and awareness on every level, with every sector,” said British Robinson, chief executive officer of the Women’s Heart Alliance. “We have to take a whole-systems approach. That system includes our medical and clinical systems, hospitals systems. It includes our physicians, our nurses, our community health workers.”
Differences between men and women are particularly salient in diseases of the heart and brain, panelists said, including heart attack and heart failure, major depression — which occurs at double the rate in women — and Alzheimer’s disease, which strikes women more frequently than their longer average lifespans explain.
More women experience heart attacks that have atypical symptoms, including heartburn, back pain, anxiousness, and fatigue. In addition, women tend toward smoother arterial plaque, which can make heart disease harder to diagnose through catheterization, panelists said.
“They’re called ‘atypical’ because the ‘typical’ was defined on the male norm, and so when women present with burning or back pain or jaw pain they’re often triaged in a different way in the emergency room,” said Marjorie Jenkins, director of medical initiatives and scientific engagement for the Food and Drug Administration’s Office of Women’s Health. “So a woman comes in. She’s anxious. She has heartburn. She has back pain. She’s questioned. She tells the doctor she’s tired. She’s really nervous. So the doctor thinks she’s having a panic attack or she’s depressed and therefore she gets medication for that. Those medications will not treat a heart attack. She needs to be screened for heart disease.”
Harvard Medical School Professor of Psychiatry and Medicine Jill Goldstein, who heads the Women, Heart and Brain Global Initiative at Massachusetts General Hospital, and Ana Langer, a professor of the practice of public health and director of the Women and Health Initiative at Harvard Chan School, also participated in the discussion on Wednesday, “Heart and Brain Disease in Women: Sex and Gender Connections.”
One opportunity for raising awareness is in research, panelists said, noting that before recent gains, women were underrepresented for decades. Even when women are included, data isn’t always analyzed by sex, missing an opportunity to tease out gender differences.
“If we don’t get the data, we won’t know the answers,” Jenkins said.
To truly understand gender disparities, researchers should design trials in a way that accounts for factors such as the natural ebb and flow of hormones, which Goldstein cited as a possible driver of differences. Studies also need to account for the influence of life stages such as puberty, pregnancy, and menopause, panelists said.