The right diagnosis and faster for women with heart problems
It often takes longer for women with heart problems to get the right diagnosis. In her Annie Romein-Verschoor Lecture, Professor Hester den Ruijter will talk about how hormones influence the heart and the importance of medical research that focuses specifically on women.
The female heart is central to your Annie Romein-Verschoor Lecture. What can visitors expect?
‘I’m going to talk about differences in men and women in cardiovascular disease because they exist and we still know too little about women’s disease profile. Medical research on the heart has historically focused on men when women are more likely to develop different types of heart problems. Men are more likely to suffer from atherosclerosis and that manifests itself in very acute and visible symptoms, such as a heart attack. In many women with heart disease, the small vessels around the heart do not work properly. Their symptoms are often more vague, such as fatigue or their bra feeling tighter, not immediate alarm bells for heart problems. So they don’t get the right diagnosis until later.’
Your research focuses specifically on women. Why is it that they have different types of heart problems from men?
‘The female heart does not differ much from the male heart, although it is somewhat smaller. Where women and men do differ is in biological processes that are controlled by sex chromosomes and hormones. The latter seems to play an important role in the development of heart problems. The hormone oestrogen, for example, protects women from atherosclerosis but its production largely stops after menopause. After menopause, women are therefore at more risk of heart problems. At the same time, we see that when the oestrogen production stops, the female body “remembers” that it once had these hormones. So it’s not the case that the protection against cardiovascular disease is lost all at once. It’s much more complex than that.’
We have known for decades that there are hormonal differences in men and women. Why is it that the female heart is only being looked at now?
‘Weird, isn’t it? Women’s specific health problems have historically been reduced to reproductive disorders: can a woman get pregnant or not? I start my lecture with a Dutch Heart Foundation advert from the 1970s. It’s called A woman and her heart and the text begins like this: “In the fight against cardiovascular disease, women have always been given an important role. They are the ones who take care of men when they come home from hospital after a heart attack.” Women used to be much better protected against cardiovascular disease because they did very physical work in the household, sat still less, smoked less and drank less alcohol. Now women have careers and they too spend whole days at a computer. Their lifestyle is more similar to that of a man and you see that in the numbers.
‘Acute problems are more common in men and they were are overrepresented in the research data’
‘For years, research focused on acute cardiovascular disease because that is life-threatening. These acute problems are more common in men, and they were therefore overrepresented in the research data. Female patient data was often overshadowed in this research because of their low numbers and this caused their results to seemingly disappear. By focusing our research one hundred per cent on women, we know more about the underlying causes and why cardiovascular diseases manifest differently in women.’
What do you hope to achieve with your research on women with heart problems?
‘One really exciting development is that we have discovered that DNA is expressed in a special way in the blood vessel walls of women with cardiovascular disease. Attached to that DNA are specific substances known as methyl groups. As these methyl groups can be detected in the blood, we can establish how dangerous atherosclerosis is in the patient. This may enable us to diagnose much faster in future.
‘And that diagnosis is where it starts. That is where the biggest gains stand to be made for women with heart problems. Then there needs to be a good treatment plan and that will be possible once we have a better understanding of how the heart became ill. I hope that we will achieve this better diagnosis and fitting treatment plan in the foreseeable future.’
What would you like visitors to your Annie Romein-Verschoor Lecture to take away with them?
‘Awareness: the idea that maybe you should talk to your friend, wife, mother or grandma about cardiovascular disease in women. And how the symptoms in women can differ from those in men.
‘There are still lots of questions to answer about women with cardiovascular disease and they need to be answered fast.’
‘Obviously, I hope that visitors will also learn something, for example about the role of hormones and how strange it is that we are only doing this research now. There are still lots of questions to answer about women with cardiovascular disease and they need to be answered fast. I hope to get that message across to people.’
Hester den Ruijter is Professor of Cardiovascular Disease in Women at Utrecht University. She studied in Wageningen and received her PhD from the AMC for a dissertation on cardiac arrhythmia and ion channels in cardiac muscle cells. She trained as a clinical epidemiologist at UMC Utrecht. She began her research into the differences in cardiovascular disease in women and men at the Laboratory for Experimental Cardiology, also at UMC Utrecht.
Hester den Ruiter will give her Annie Romein-Verschoor Lecture Hartenvrouw (Queen of Hearts) on 8 March at 20.00. (The lecture will be in Dutch.) Registration is required for the lecture. The Annie Romein-Verschoor lecture will also be streamed live.
Text: Tim Senden