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24 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, September 24, 2025
Women and Heart Disease
Continued from page 13
them. Women may have other symptoms
that are typically less associated with heart
attack, such as:
• Anxiety
• Shortness of breath
• Upset stomach
• Pain in the shoulder, back or arm
• Unusual tiredness and weakness
“There are gender-based gaps at every
possible level, from women’s awareness
of symptoms to how they’re treated in
the emergency department and doctor’s
offices,” says cardiologist Dr. Michelle
O’Donoghue, associate professor of medicine at Harvard Medical School.
In 1990, the Society for Women’s Health
Research (SWHR) was founded by Dr.
Florence Haseltine to confront this injustice and change the culture of medical
research. Thanks to SWHR and other
advocacy groups, women are now routinely included in medical research and
make up a larger portion of the scientific
workforce, and scientists are studying
how biological sex differences affect the
prevention, diagnosis, and treatment of
disease. https://swhr.org/
“Women don’t necessarily present differently than men, but they frequently attribute their symptoms to other problems,”
says Dr. Erin Donnelly Michos. “They often
will have some chest symptoms in 90% of
cases, described as pressure or tightness,
but they may also have discomfort in their
backs, their jaws, suffer from shortness
of breath, severe fatigue, or nausea. They
often have multiple other symptoms but
not chest pain. These are symptoms, but
when women see their physicians, both
they and their doctors sometimes think it’s
something other than a myocardial infarction. Then they don’t receive an accurate
diagnosis or get treated promptly.”
“We have closed much of the gender
gap,” says Bairey Merz, “by deploying
guidelines for treatment and therapy, but
the clear and present danger is that the
incidence of heart disease is increasing in
young women. Why is it on the rise with
them? We don’t know. We’re not back to
the 1970s, but, until we understand how
to diagnose and treat women specifically,
the gap will continue, and women’s lives
unnecessarily lost.”
“We are not doing better,” Michos says.
“Yes, heart disease is on the rise among
those under 45. Young women don’t think
they are at risk for heart disease; however,
we are seeing increased rates of obesity
and diabetes in young adults, which are
risk factors for cardiovascular disease.
We want to alert the younger women
about optimizing their cardiometabolic
health, a term that covers heart, blood,
and blood vessels. The young adults we
see these days are less healthy than in the
past, many with both traditional factors
and female-specific risk factors, such as
adverse pregnancy outcomes that impact
their heart risks in the future.”
Case Study: A young woman with a
family history of heart disease worked hard
to keep herself healthy. Despite maintaining normal cholesterol numbers, plaque
built up on the walls of her arteries. At
age 39, she almost died of a heart attack
caused by a 95% blockage. Further testing
showed the likely problem: she had high
numbers of lipoprotein(a), or Lp(a).
“It is important to know your numbers for the traditional risk factors like
blood pressure, glucose, and cholesterol,” Michos emphasizes, “but in addition
to those tests, have a lipoprotein(a) test
once. It will tell you if you are susceptible
to having plaque in your arteries. It’s not
included in a standard lipid panel, and it
is genetically determined so people could
have high levels even if they are following a healthy diet. However, following a
healthy lifestyle is very important. The first
half of your life will impact the second half.
While you are young, get your body as
healthy as possible.”
Bairey Merz commented on the rising
rates of heart failure and poor outcomes.
“We are seeing more cardio-oncology, a
woman with heart disease and some form
of cancer. We have made significant progress in the identification and treatment of
risk factors for coronary artery disease
(CAD). We’ve also improved diagnoses of
heart disorders in women using non-invasive methods, such as an electrocardiograms (ECGs), echocardiograms, and
stress tests, which help assess heart function and identify potential issues. These
were resulting in a decline in cardiovascular mortality for men and women in the
U.S., however rates are climbing again.
“We are still seeing gaps in how women
are treated versus men. Even though every
product has to be tested on all those who
could use it, one recent problem was with
Ambien. It turned out it was tested on
women but not acted on at the time of
FDA approval; for women, it metabolized
more slowly so this caused it to last longer, a problem with a sleeping pill that had
residual effects in the morning that could
interfere with activities such as driving.
This type of error can cause long-reaching
problems.
Women are typically slow to complain.
They are better at taking care of oth-
ers than themselves. A cMRI—cardiac
MRI— provides an emerging ability to
evaluate the hemodynamic (blood flow)
characteristics of the small vessels in the
human heart. This means there is finally a
noninvasive diagnostic tool that will allow
cardiologists to see what is going on in a
woman’s heart and take actions to save
her life. Invasive coronary function testing
also can be used.
Prevention is the key. Risk factors
should be addressed. Take care of your
hypertension, your high cholesterol. Do
more than check them. Act on changing
those numbers into something positive.
Look at your lifestyle. Prevent risk factors
from occurring in the first place and pay
attention to prevention.
Talk with your daughters and granddaughters. If you have a history of heart
disease in your family, let them know.
Don’t let the next generation die of heart
disease. It’s up to us to look out for them.
About the Experts
Dr. C. Noel Bairey Merz, M.D. is
director of the Barbra Streisand Women’s
Heart Center, Director: Linda Joy Pollin
Women’s Heart Health Program, Irwin
and Sheila Allen Chair in Women’s Heart
Research, in the Smidt Heart Institute
at Cedars-Sinai Medical Center in Los
Angeles and Professor of Medicine. She
is also chair of the National Institutes of
Health (NIH)-sponsored WISE (Women’s
Ischemic Syndrome Evaluation) initiative.
Ranked #1 Heart Program in the West,
USN&WR 2013-2025
Watch her TED talk at https://www.ted.
com/talks/noel_bairey_merz_the_single_
biggest_health_threat_women_face?language=en
Dr. Erin Donnelly Michos, M.D., is a
Professor of Medicine within the Division
of Cardiology at the Johns Hopkins
School of Medicine, with joint appointment in the Department of Epidemiology
at the Johns Hopkins Bloomberg School
of Public Health. She is the Director of
Women’s Cardiovascular Health and
the Associate Director of Preventive
Cardiology within the Johns Hopkins
Ciccarone Center for the Prevention of
Cardiovascular Disease.
https://profiles.hopkinsmedicine.org/
provider/erin-donnelly-michos/2705593
