Co-authored by Jill Lesser, President of WomenAgainstAlzheimer’s and British Robinson, Chief Executive Officer of the Women’s Heart Alliance.
What if we could access knowledge that would transform modern medicine, enabling better disease prevention, better clinical decision-making, better therapeutics and better health outcomes for all Americans?
We don’t have to imagine. The answer lies in making medical research truly inclusive—in part, by filling the widespread gender, racial, and ethnic gaps in clinical trials; and most significantly, by studying sex differences in disease. These differences include the risk factors women and men face, the way they develop and experience illness, and the way they respond to treatment.
Sex matters. Every cell has a sex, and male and female cells react differently to the same stimuli. Understanding sex differences can revolutionize how we diagnose, care, and cure disease, from catalyzing therapeutic breakthroughs and innovations to driving meaningful advances in women’s health and, thus, strengthening society as a whole.
That is why, at a time when the promise of precision medicine is gaining momentum, sex-based research should be at the forefront—beginning with heart disease and Alzheimer’s disease.
Many people are surprised to learn that heart disease and stroke are the number one killers of women. In fact, they kill one woman roughly every 80 seconds—more women each year than all cancers combined. Women often experience different symptoms than men. They respond differently to some preventative measures. And women are at greater risk of dying in the year following a heart attack than men: 1 in 4 women will die within one year of their heart attack, compared with 1 in 5 men.
Meanwhile, Alzheimer’s disease is fast becoming the 21st century’s greatest health crisis. Already, it afflicts one in nine Americans over the age of 65—two-thirds of them women—and a new case is diagnosed every 68 seconds. Compared with men, women have more than twice the overall lifetime risk of developing Alzheimer’s. As of right now, there is no known cause, no method of prevention and no cure.
These terrible diseases impose tremendous costs on our society—from the disabling and loss of individual lives to the emotional and financial burden on families. Beyond the human toll, heart disease and Alzheimer’s total $430 billion in direct and indirect costs to the U.S. health care system, which is vastly more than the amount of money we invest in their research.
Sex-based research can maximize the value of our health research spending, enabling insights that benefit the lives of women and men alike. We’ve learned, for example, that women with certain gene mutations are two and a half times more likely to be at higher risk for heart disease. We’ve learned that the way women’s blood pressure responds to mental stress renders stressed women significantly more vulnerable to heart attacks than their male counterparts. We’ve learned that the depletion of sex hormones is a risk factor for Alzheimer’s, which has particular implications for post-menopausal women. We’ve learned that women with mild cognitive impairment decline twice as fast as similarly impaired men.
The more such discoveries we make and understand, the more opportunities we’ll have to create diagnostics, interventions and therapeutics tailored to how people’s bodies actually work. Conversely, failing to fully include women and minorities in medical research makes it impossible to effectively translate research results into clinical practice.
Sex-based research could also lead to breakthroughs in areas we’re just beginning to understand, sharpening our ability to combat heart disease and Alzheimer’s simultaneously.
That’s because some of the same brain regions that regulate our response to stress and cardiac tone are also implicated in memory function. The brain and the heart are connected through nerves, hormones and immune regulatory pathways, and, as pioneering medical researchers have shown, sex differences are critical in understanding how these pathways develop. If researchers could map out how and when crucial pathways are disrupted, and how that process differs in men and women, the impact could be historic. Doctors could pinpoint the best time to intervene and scientists could develop sex-dependent therapeutics that have a greater chance of success.
But, for all this to happen, we need a fundamental shift in our national attitude toward the inclusion of sex-based differences in medical research. More than 20 years since Congress mandated that the National Institutes of Health (NIH) include women and minorities in clinical trials, we still need more focus, funding and urgency to ensure that sex-based research gets the priority it deserves. In 2014, NIH started rolling out new policies requiring sex and gender inclusion and reporting in applications for preclinical research. Indeed, all NIH funding should require gender neutrality across the board.
The time to act is now. Congress is poised to act on The 21st Century Cures legislative package, which contains provisions that require the inclusion of women and minority populations in clinical research. This legislation will improve the pace of progress. We are urging policymakers to pass it now, so that, collectively, we may seize the full potential of personalized medicine, save money and save lives.
Follow Women’s Heart Alliance on Twitter and visit www.womensheartalliance.org.
Follow WomenAgainstAlzheimer’s on Twitter and visit www.wewontwaitcampaign.org.