The hearts and blood vessels of women and men differ in several ways. Yet much of what we know about cardiovascular disease is based on research that has primarily focused on men. Researchers from UMC Utrecht brought together key knowledge about these differences and describe what is needed to improve cardiovascular care. Their main message: take biological differences into account from the very start of research, so that diagnosis and treatment can better reflect them too.
For a long time, researchers assumed that knowledge from studies in men also applied to women. But there are important differences. On average, women have smaller hearts, higher resting heart rates, and narrower coronary arteries. Yet healthcare does not always take these differences into account.
Elisa Dal Canto and Ernest Diez Benavente, both assistant professors at UMC Utrecht, therefore examined how much research has been conducted into different cardiovascular diseases. They found that conditions that predominantly affect women have received far less research attention and that research into these conditions started much later in time. Their findings have been published in Nature Medicine.
But simply identifying where knowledge is lacking was not enough for the researchers. “We wanted to take it a step further: what can we learn from this, and how can we make sex a standard consideration in research?” Dal Canto says.
That starts in the laboratory. Cell research is not sex-neutral either, Dal Canto and Diez Benavente emphasize. For example, researchers do not always use cells from both female and male donors. As a result, biological differences can already be overlooked at an early stage of research.
These differences also need to be considered in clinical studies. Women are still relatively underrepresented in much cardiovascular research. “This leaves you with little or insufficient evidence,” Diez Benavente says. “And without that evidence, it becomes difficult to improve guidelines.” This creates a cycle: limited research leads to limited evidence, making it less likely that differences will find their way into healthcare.
Doctors also need to translate existing knowledge more effectively into clinical practice. “With MRI and ultrasound, for example, we measure the size of the left ventricle and atrium and how blood flows through the heart,” Dal Canto says. “We know that some of these values differ between women and men, but for many measurements we still do not use separate reference values.”
Taking these differences into account makes diagnosis more complex and requires additional knowledge from healthcare professionals. Still, Dal Canto believes this development is inevitable. “If we acknowledge that people differ from one another, things become more complex. But it also means that we can tailor diagnostics more closely to what each patient needs.”
Clear medical terms and definitions are also sometimes needed to move research forward. Dal Canto points to HFpEF, a form of heart failure that is more common in women. “HFpEF is a good example of how well a research field can develop once there is a shared language and clearer diagnostic criteria. When researchers study the same condition in a more consistent way, it becomes much easier to build evidence, and you can really see the research take off,” she says.
A shared definition makes it easier to compare studies, bring knowledge together, and collaborate more effectively. This provides a clearer picture of what researchers already know and which questions remain unanswered.
Improving cardiovascular care for women is not about making a single adjustment, but about changing how research is conducted. “You have to build that knowledge step by step, so that we can ultimately translate it into guidelines and better care,” Diez Benavente says. This can create knowledge that better reflects everyone living with cardiovascular disease.
