When Dr. Bernadine Healy passed away in 2011, she left behind a legacy of bolstering biomedical research on women’s health. While Director of the NIH, she established a policy to fund only those clinical trials that included both men and women when the condition being studied affected both sexes. It was during her tenure as NIH director that the NIH launched the landmark Women’s Health Initiative, which is now housed within the National Heart, Lung, and Blood Institute. And later, as president of the American Heart Association, she crystalized the problem in an article in the New England Journal of Medicine writing, “The problem is to convince both the lay and medical sectors that coronary heart disease is also a women’s disease, not a man’s disease in disguise.”
Dr. Healy’s emphasis on this issue no doubt contributed to the increasing prevalence of female representation in biomedical research. Here at the National Heart, Lung, and Blood Institute, we are proud of our long history of including women in research, starting with the Framingham Heart Study in 1949 and continuing through many pioneering studies that have greatly contributed to improving women’s health and our knowledge about women and heart disease.
Notable examples include:
- The Women’s Ischemia Syndrome Evaluation (WISE) study, launched in 1996, studied a cohort of 1,000 women with chest pain undergoing coronary angiography. WISE demonstrated that 50 percent of women with chest pain but normal angiographs had microvascular disease and were at increased risk for coronary events. As a result, millions of U.S. women who otherwise may not have been identified as at risk can now benefit from aggressive risk management.
- The NHLBI-supported Women’s Health Initiative (WHI) Study, which demonstrated—utterly contrary to conventional wisdom—that use of the widely-prescribed estrogen/progestin postmenopausal hormone therapy not only failed to protect women from coronary heart disease but also increased their risk of developing invasive breast cancer. In the aftermath of this study, there was a dramatic reduction in the number of women on combined hormone therapy resulting in fewer cases of cardiovascular disease and breast cancer.
Our robust portfolio continues to support a broad range of research on women’s health from the pathophysiology of heart disease, specifically in women, to prevention, treatment, utilization of evidence-based practices, and outcomes research. For example, a recent study by NHLBI-funded investigator Dr. Viola Vaccarino found that, when exposed to an emotional stressor in a laboratory setting, women age 50 or younger showed approximately twice the levels of myocardial ischemia (i.e., insufficient blood flow to the heart muscle) compared to men of the same age with similar characteristics. Research such as this can inform the development of targeted interventions to identify women at risk earlier in the disease process and prevent disease progression. And three current initiatives are using the wealth of clinical and biomarker data collected by the Women’s Health Initiative and combining it with new so-called “omics” technologies in the hopes of gleaning new insights into the role that genomics, metabolomics (i.e., metabolite signatures), and chromosome biology may play in the risk for or development of coronary heart disease.
As we recognize the 70th birthday of Dr. Healy and her contributions to the field of research on women’s health, we use the occasion to commemorate NHLBI’s history and dedication to this issue – as well as the work of the larger research community – but we recognize that our work isn’t finished. There is still more that must be done to better understand, prevent, and treat women’s health issues. Our hope is that the entire research community – from researchers to industry, from patient advocacy groups to the patients who choose to participate in research – will continue to work together to ensure women are sufficiently represented so that Dr. Healy’s legacy can continue but more importantly, that women might fully realize the same benefits of biomedical research.