Tag Archive for: cardiovascular

Sex-specific risk factors for cardiovascular disease in women

Author: Natalie Szakun, UBC Island Medical program, MD candidate, Integrative Cardiovascular Physiology Laboratory, Trinity Western University | Editors: Emily Anne Opala (Program Officer), Romina Garcia de leon, and Janielle Richards  (Blog Coordinators) | Expert Reviewer: Jennifer Williams 

Published: January 10th, 2025

The viral Instagram song “We’ve Never Really Studied the Female Body” by Farideh (@ilovefarideh) has struck a chord by humorously highlighting serious conditions like endometriosis and polycystic ovarian syndrome, shedding light on how women’s health concerns are often dismissed or trivialized. This song resonated with women who are frequently told their symptoms are exaggerated or imagined (as Ferideh ironically emphasizes). The song’s impact is evidenced by its 1,275 video responses and over 2.5 million views at the time of writing this blog, reflecting a collective frustration and desire for change. This surge in public engagement underscores a broader movement towards acknowledging and addressing the longstanding neglect of women’s health in medical research. 

Leading Cause of Death

Cardiovascular disease (CVD) has been the leading cause of death worldwide for over 20 years, with one in three women affected by heart disease. However, our understanding of the impact of CVD in women remains inadequate. Many still hold the misconception that CVD primarily affects men. Although more women die of CVD, a  2017 study surveying Canadian physicians found that 38% of primary care physicians and 32% of cardiologists believed more men die from CVD. 

Women continue to receive insufficient, suboptimal care, as evidenced by lower rates of diagnosis, preventative care, attention, and treatment.  For instance, women are less likely to be treated with guideline-recommended drugs (such as aspirin or blood pressure medication) after a cardiac event compared to men. Additionally, over 50% of women’s heart attack symptoms go unrecognized. Perhaps most starkly, women have a 40% higher population-adjusted risk of mortality from CVD compared to men.

Examining Sex-Specific Risk Factors 

It is incredibly frustrating that we know so little about the leading cause of death for a demographic that represents over half of the population. This is one of the driving forces behind the work of Dr. Anita Coté and her team at the Integrative Cardiovascular Physiology Laboratory at Trinity Western University.

Historically, the medical system has attributed the increased CVD death rate in women to a delayed onset of symptoms, as women typically present CVD symptoms about 10 years later than men. This often results in a delayed diagnosis for women whereby the disease is more advanced, resulting in a poorer prognosis. Recently, however, work in the Coté lab has made it clear that this logic is flawed. While delayed symptom presentation contributes to the problem, there are also the unrecognized sex-specific risk factors (SS-RF) that many women silently carry. 

Sex-specific CVD risk factors are specific conditions, attributes or exposures that increase one’s risk of developing CVD in the future. Some examples of SS-RF include, adverse pregnancy outcomes, polycystic ovarian syndrome, endometriosis, breast cancer treatments, and early age of first menstruation (before age 12) are linked to increased CVD rates and associated deaths. Many women are unaware of the relationship between these risk factors and CVD, yet a significant proportion of women are affected. For example, in a study by Dr. Coté, of pre-menopausal Canadian women, 41% had one or more SS-RF. 

Current CVD risk screening tools – when will we think of women?

Current screening tools often overlook significant SS-RFs, which reduces their sensitivity in predicting risk. In Dr. Coté’s research, 82% of premenopausal women were classified as low risk when considering traditional CVD risk factors (e.g. smoking, high blood pressure, diabetes); However, over a third of these women had one or more SS-RF. Given their young age and pre-menopausal status, their risk was expected to be low but when SS-RFs were included, Dr. Coté’s lab discovered that 47% of the women in their study may be at risk for developing CVD.

Incorporating SS-RFs into current risk prediction tools is more complex than simply adding a few checkboxes. Although this is a good place to start, more research in this area is urgently needed to develop effective strategies for reducing this future risk. 

Future Directions

The lack of comprehensive research on women’s health, particularly regarding CVD, is a significant issue that demands immediate attention. Farideh’s song, “We’ve Never Really Studied the Female Body,” poignantly highlights the common experience of countless women who have been misdiagnosed or dismissed.

As awareness grows and more voices join the conversation, hope for change exists. For example, the organisation Wear Red Canada raises awareness about women’s heart health by hosting yearly events on February 13th to increase women’s knowledge, curiosity and action to prevent CVD and improve heart health. The work being done by researchers like Dr. Coté, and organisations such as Wear Red Canada, is paving the way for a future where women’s health is no longer a secondary consideration but a priority.

Importance of considering minority stress when conducting cardiovascular health research in transgender, gender-diverse and non-binary populations

Authors: Raquel Rodriguez, BSc Kinesiology, McGill University | Editors: Romina Garcia de leon, Janielle Richards (Blog Co-Coordinators) | Expert Reviewer: Lindsey Thurston

Published: Friday November 1st, 2024

Transgender, gender-diverse, and non-binary (TGD) individuals are people whose gender identity does not align with their sex assigned at birth. TGD people face unique stressors related to their stigmatized gender identity and expression and are thus more likely to experience mental health issues compared to cisgender individuals, whose sex assigned at birth aligns with their gender identity. These unique stressors are known as minority stressors which include external conditions and events (i.e., discrimination and victimization) as well as internal factors (i.e., expectations of discrimination and internalization of negative societal attitudes). Increasing evidence indicates that TGD individuals face disparities in various cardiovascular (CV) risk factors and higher rates of CV morbidity and mortality compared to their cisgender peers. The population of individuals who identify as TGD is growing, as such, it is important to quantify minority stress when conducting cardiovascular research in TGD populations.

TGD & Minority Stress

The leading explanation for the health disparities observed between TGD and cisgender individuals is the minority stress theory. This theory states that, in addition to the common stressors faced by everyone, members of minority groups, including the TGD community, endure a greater range of unique stressors due to their minority status. These unique stressors are either external in nature (i.e., distal stressors) or are felt internally by the individual (i.e., proximal stressors). Distal stressors include experiences such as misgendering, stigma, discrimination, rejection, and victimization based on their gender identity. Proximal stressors include internalized stigma or transphobia, negative expectations, and concealing one’s gender identity. The theory also states that some of these individuals may also experience individual- and/or community-level resilience as a result of their minority status, allowing them to persist and thrive in the face of adversity against these stressors.

Minority Stress & How it Affects Cardiovascular Outcomes

Both internal and external stressors can negatively affect the body’s homeostasis. Psychosocial stress is an inevitable part of daily life and it is linked to an increased risk of CV disease (CVD) events. Acute and chronic mental stress are both associated with the long-term development of CV issuesDistal and proximal stressors raise the overall stress levels of TGD individuals beyond those faced by the cisgender population, negatively affecting CV health behaviours and increasing the risk of various poor mental and physical health outcomes, including CVD.

Minority Stress & Cardiovascular Health Behaviours

TGD populations have higher chances of negative CV outcomes and associated risk factors as a result of a variety of multifaceted health behaviours. TGD persons may participate less in regular physical activity than the cisgender population which puts them at a higher risk of developing CVD. Moreover, TGD adolescents have self-reported more disproportionately unsafe weight management and disordered eating behaviours compared to their cisgender peers. Research has reported elevated levels of alcohol use within the TGD population compared to the general population as a result of victimization, bullying, and minority stress.

Future Directions

Research in TGD populations should prioritize the unique impact of minority stress on cardiovascular health outcomes. Unlike research conducted on cisgender individuals, studies on TGD populations must consider distal and proximal stressors like discrimination and internalized stigma. Improved measurement tools that capture the full range of minority stressors are essential for reliable research findings. By incorporating these unique considerations, future research can contribute to a more accurate and comprehensive understanding of TGD health, ultimately leading to better health outcomes for this medically underserved and growing population.

Why is this topic important? 

This topic is important because the growing population of TGD individuals deserve and require proper and accurate healthcare services which stem from properly conducting research to accurately depict their physiological capacities. Researchers cannot conduct studies on this population in the same way as they do cisgender people as there are unique factors to consider when properly assessing the TGD population. The minority stress that they experience contributes to their cardiovascular capacities and therefore cannot be neglected when doing research on the TGD population.

Women’s Health Interrupted Podcast: Season 2 Recap

Authors: Edidiong Daniel, BSc. Environmental Toxicology | WHRC Social Media Committee Member | Editor: Romina Garcia de leon Reviewer: Bonnie Lee

Published: July 19th, 2024

We’ve come to the end of Season 2 of the Women’s Health Interrupted Podcast! – a podcast that centers on women’s health across these four themes: general health and wellness, brain health, socio-cultural determinants of health as well as politics, policy, and advocacy. The second season of the Women’s Health Interrupted Podcast was hosted by UBC’s Masters of Journalism students, Chhavi Mehra and Sarah Williscraft, and featured guests across various institutions and fields. All episodes are available on any major podcast streaming platform. If you haven’t tuned in yet, here’s a quick recap!

Season 2 kicked off with Dr. Lori Brotto, a professor in the UBC Department of Gynecology, a registered psychologist in Vancouver, and Executive Director of the Women’s Health Research Institute of BC, discussing Cultivating Female Sexual Desire through Mindfulness. Dr. Brotto shared the role of mindfulness and environmental influence in cultivating female sexual desires and discussed the orgasm gap and contributing factors, while also debunking some myths surrounding female sexuality.

Next, we had Dr. Najah Adreak, a clinical researcher and an advocate for cardiovascular health and treatment, especially for underserved women patients, for episode two: Why are Women’s Cardiovascular Concerns Often Downplayed? Dr. Adreak discussed why women’s cardiovascular health is often downplayed and also shed light on the knowledge gaps in women’s cardiovascular health, the differences between male and female hearts, how hormonal changes and social determinants of health can affect women’s heart health long-term, and the role of physicians in filling the knowledge gaps in female cardiovascular health.

In the third episode: All You Need to Know about Gynecological Cancer, co-hosts of the Gynecologic Oncology Sharing Hub (GOSH) podcast Nicole Keay and Stephanie Lam told us everything we should know about gynecological cancer, explaining how gynecological cancer differs from other forms of cancer and the importance of researching these cancers as separate entities. Nicole and Stephanie also shared new research tools for gynecological cancer such as the Opportunistic Salpingectomy for prevention strategy and the Proactive Molecular Risk Classifier for Endometrial Cancer (ProMisE) for endometrial cancer diagnosis.

Dr. Lindsay Larios, assistant professor at the University of Manitoba’s Faculty of Social Work, joined us to discuss Abortion Rights with Precarious Immigration Status, highlighting the challenges in accessing abortion and general reproductive care as immigrants in Canada. Dr. Larios explained how access to reproductive care for pregnant immigrants differs based on class, race, ethnicity, and other socioeconomic factors, the difference between private and public health insurance for immigrants, the importance of including reproductive rights and justice framework in Canada’s immigration system, and reforms and repairs that need to happen.

For episode 5: Housing and Health Barriers Faced by 2SLGBTQ+ Youth, Dr. Alex Abramovich, an Independent Scientist with the Institute of Mental Health Policy Research at The Centre for Addiction and Mental Health, took us through the current state of housing access for 2SLGBTQ+ Youths in Canada. Dr. Abramovich laid out some factors that impact access to housing for 2SLGBTQ+ youths in Canada and shared some useful resources for 2SLGBTQ+ youths experiencing homelessness. 

PhD student, Amanda Namchuk, and recent B.Sc. in Biology graduate, Tallinn Splinter, came on the podcast to discuss the Exclusion of Women from health Research: Then and Now. Amanda and Tallinn helped differentiate between sex and gender and addressed the need for sex and gender-based research using the difference in the breakdown of Tylenol in men and women, among others, as a clear case study. They also explained how the exclusion of women in research impacts historically underserved communities and the role of big institutions like the Canadian Institutes of Health Research (CIHR) and journals in ensuring sex and gender are properly incorporated in scientific research.

Featuring Dr. Ann-Marie de Lange from the University of Oxford, and Dr. Claudia Barth, biologist and cofounder of the Women’s NeuroNetwork, we went deep into the brain for episodes 7 and 8. Dr. Ann-Marie de Lange discussed some common misconceptions about how pregnancy affects the brain, highlighted some changes that happen to the brain during pregnancy and after birth, and shared what women can do to improve their brain health for episode 7: Mommy Brain: It’s Not Just in Your Head. In episode 8: How Does Menopause Affect the Brain, Dr. Barth shed light on some hormonal changes that happen to the brain during menopause, menopausal symptoms, the impact of menopause on mental health and neurological disorders, and the need to educate women and men on menopause.

Dr. Debra Anderson, Dean of the Faculty of Health at the University of Technology Sydney, explained how lifestyle factors and health behaviors such as smoking, exercise, and nutrition can impact quality of life in the ninth episode: This is How You Can Improve Your Quality of Life. Dr. Anderson also stressed the importance of looking at women as a whole and also shared a shocking revelation on how big a role calcium plays in reducing premenstrual syndrome (PMS).

For episode ten: Domperidone for Low Milk Supply: Is it Safe? we were joined by Dr. Janet Currie, a social worker and the founder and director of Focus Consultants, and Dr. Suzanne Hetzel Campbell, a professor at UBC School of Nursing, to discuss the use of domperidone, a drug approved to treat stomach problems in Canada, in treating low milk supply in breastfeeding mothers. Dr. Currie and Dr. Campbell mentioned some factors that have contributed to the dramatic increase in domperidone use, safety concerns, and what Health Canada can do to better regulate the safe and effective use of off-label drugs like domperidone.

Finally, we had Kirann Mann, a first-year obstetrics and gynecology resident at McMaster University, for our eleventh episode on Breaking the Stigma Around Pelvic Floor Dysfunction. Kirann explained the pelvic floor, what it does, and the importance of maintaining pelvic floor health, and listed some symptoms of a weak pelvic floor and stressors in one’s life that impact pelvic floor health. Kirann also explained how socioeconomic factors like socioeconomic status, education level, and racial and ethnic background can create disparities in gaps and knowledge, and shed light on how the pelvic floor awareness campaign builds community surrounding pelvic floor health.

What an incredible journey Season 2 took us on. The Cluster is so grateful to all the wonderful experts that took the time to sit down with us and discuss these timely women’s health topics with us. We hope you were able to learn a new thing or two from all the different disciplines and perspectives featured throughout Season 2. All episodes and corresponding resources can be found on our website. We hope you join us for Season 3. Stay tuned!

 

 

Same Disease, Different Risks & Symptoms: Cardiovascular Disease in Women

Authors: Nabilah Gulamhusein: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Elaha Niazi: Libin Cardiovascular Institute & Cumming School of Medicine, University of Calgary; Smriti Juriasingani: Cumming School of Medicine, University of Calgary 

Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

 

Cardiovascular disease is the leading cause of death among women worldwide, and in fact, women are more likely to die from a heart attack than men. This often surprises women and their care providers because cardiovascular disease has traditionally been considered a male-dominated disease. Deaths due to cardiovascular disease have declined in the last 50 years in men, but have risen in women, especially in younger women. It is increasingly apparent that there are both sex-based (related to biological attributes) and gender-based (related to socially constructed identities, expression, roles, and behaviors) differences in cardiovascular risk factors, as well as the development and progression of cardiovascular diseases. Though we have made great gains in improving men’s heart health, women remain under-researched, under-diagnosed, under-treated, and under-supported; consequently, many women are unaware of their cardiovascular disease risk. 

 

Though many consider cardiovascular disease only a disease of older women, it affects women at all life stages. Reproductive-aged women have been developing increasingly disadvantageous cardiovascular disease risk profiles, including obesity, physical inactivity, an unhealthy diet, and stress; these factors appear to have a larger impact on women than men. While these are certainly important considerations in cardiovascular disease risk for young women, it is time to adopt a broader understanding of female-specific risk factors.

 

In addition to traditional risk factors, female-specific and female-predominant factors contribute to cardiovascular risk. Conditions related to fertility, such as polycystic ovarian syndrome and menstrual irregularities, have been associated with an increased cardiovascular disease risk. In addition, certain pregnancy complications can increase heart disease risk, including gestational hypertension and diabetes. It is critical that women have the opportunity for informed discussions with healthcare providers to mitigate reproductive and pregnancy-related risks. There is also a multitude of medical conditions disproportionately impacting women that result in increased cardiovascular risk. These include depression, diabetes, hypertension, autoimmune diseases, and chronic kidney disease. Awareness of these important female-specific and female-predominant risk factors can empower women in making heart-healthy choices. 

 

There is no question, however, that as a woman ages, cardiovascular risk increases considerably due to changes in the heart and blood vessels. The timing of the onset of menopause, as well as perimenopause (when the transition to menopause begins, but before a final menstrual period), may influence a woman’s cardiovascular risk. Premature menopause (before age 40) and early menopause (before age 45) are significantly associated with increased cardiovascular risk. Additionally, cardiovascular disease risk commonly increases after menopause, which is attributed to changes in hormone levels (e.g., estrogens).

 

Early heart attack symptoms are missed in more than 50% of women and therefore, it is important to recognize that women may have different symptoms compared to men during a heart attack. While women experience symptoms such as sharp chest pain, they may also have aching sensations across the back and stomach, pain in the jaw, neck or arm, shortness of breath, abnormally excessive sweating, nausea, indigestion, and extreme fatigue. Unlike men, women are more likely to present with three or more symptoms in addition to chest pain when having a heart attack. Being informed and spreading the word about heart disease symptoms in women is the first step towards protecting the women in our lives. 

 

Knowing that women have unique cardiovascular risk factors and subtle symptoms can be overwhelming, however, heart disease is largely preventable. First, following Canada’s 24-hour movement guidelines, including getting 150 minutes of moderate to vigorous physical activity per week, reducing sedentary time, and getting enough good quality sleep is recommended for a healthy lifestyle. Research shows that consuming 7-10 servings of fruits and vegetables every day, while limiting processed foods, sugar and salt are key ways to reduce cardiovascular risk. It is also important for women to have regular check-ups with their healthcare providers and take their medications as prescribed. Finally, living free from commercial tobacco and vaping while reducing alcohol intake and actively managing stress can also be beneficial.  

 

To learn about women’s cardiovascular health, including risk factors, symptoms, treatment, and support, you can participate in Wear Red Canada or visit WearRedCanada.ca! Wear Red Canada is run by volunteers across the country, including healthcare providers, scientists, and people with lived experience. Wear Red Canada Day is celebrated annually on February 13th to raise awareness about women’s heart and vascular health. Each year, you are invited to attend presentations by leading experts, join the Wear Red Canada Movement Challenge, and visit local landmarks that will light up RED in support of women’s heart health. On February 13, wear RED and join us on social media to share selfies or pictures of your participation in these events with the hashtag #HerHeartMatters and tag @WearRedCanada to share this important message. By starting conversations about women’s cardiovascular health and getting informed, we can increase awareness and improve the health of the women in our lives.

 

 

 

 

Sex Differences and the Brain-heart Connection

Author: Emilie Théberge, MSc. Medical Genetics, Clinical Research Coordinator (University of British Columbia/Vancouver General Hospital)   Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators).

Published: December 30th, 2022.

Note: Biological sex (i.e. female, male) is not the same as gender (i.e. woman, man, nonbinary, Two-Spirit, etc.), which is a social construct. Throughout this blog post, the cited literature considers the term “women” to equate to cisgender females, and the term “men” to cisgender males. This post’s cited conclusions of sex differences are under researched in reference to transgender and non-binary individuals, as well as those with non-conforming gender identities.  Read more 

When does stress overwhelm the body to the point that it causes a state of mental and/or physical illness with an accelerating feedback loop? If the cause of stress is unremovable, how can we adapt and find hope?

A large-scale wildfire may cause short-term (acute) stress to someone nearby, but there is also a defined endpoint when the fire is put out and no longer a threat. However, there can be long-term (chronic) consequences to one’s lungs and the local environmental ecosystem This wildfire metaphor may be translated to the acute and chronic mental and physiological adaptations caused by stressful events. Everyone has different thresholds of stress tolerance based on their lived experiences and  biological (genetic) susceptibility to how their bodies manifest this stress.  

 Despite being half of the world’s population, I am shocked at how little research in psychiatric and neuroscience is dedicated to studying sex differences and women’s health. Approximately one in four Canadians were estimated to have depression in 2021 – and across borders, depression rates are consistently reported twice as high in women (20%) than in men (10%). How much of this is attributed to biological sex differences? Do the physical manifestations of mental stress and depression differ between the sexes? I decided to explore these ideas in my thesis. 

This recently published article on the “immunometabolic theory of depression” piqued my interest. Most literature on depression focuses on dysfunction within the brain, ignoring the context of its link to the cardiovascular and metabolic systems. Recent genetics literature on depression has pointed towards genes and molecular pathways that implicate the immune system, specifically chronic-low-grade inflammation, as a key driver of depression. The brain controls the perception of stress, and the heart reacts to it. Chronic low-grade inflammation is a result of this system staying “on” too long after the perceived threat has passed. 

Depression is a systemic and  whole-body concern that can affect our cardiovascular system. I developed a keen interest in exploring these connections when working with patients who believed that stress triggered their cardiovascular disease onset. Heart disease does not occur overnight. Chest pain to the point of a heart attack comes from a complex interaction of metabolic and immune factors that build up over time from imbalances in the body (i.e. from stress). This can manifest as plaque in the large blood vessels with coronary artery disease or dysfunction of the smallest blood vessels with microvascular dysfunction. Traditional risk factors such as high cholesterol, diabetes, high blood pressure, smoking, and obesity, may also have different effects between men and women. 

In my thesis, I studied a sample of over 16,000 people from the Canadian Longitudinal Study on Aging (CLSA) cohort of 50,000 people and found sex differences in the genetic and cardiometabolic risk factors associated with depression. Women with a history of clinical depression were at higher odds of having comorbid histories of heart disease, diabetes, hypothyroidism (which results in slower metabolism), and a higher “genetic risk score” for depression. However, men with depression did not show significant relationships with these conditions, in comparison to men without depression. Among men, high blood pressure was a significant risk factor, while high genetic risk was not. Younger age and lower annual income contributed the most to my statistical models for both sexes. 

Depression is not just in the head, it’s a whole-body dysfunction to cope with stress. In consultation with your primary health care provider, you can make a habit of checking on your body through regular health examinations and seeking support for your mental health. Mental and physical health are interconnected, and gradual mental and physical decline in our youth have the potential to snowball into early life-threatening heart disease. It is imperative that we talk about the individual and collective actions that we can take to treat depression, especially in this post-COVID era. This can take place in our friend groups, families, and workplaces – as we think about long-term solutions instead of “quick fixes.”

 

In-vitro Fertilization and Heart Disease: Is There a Link?

Author: Elaha Niazi, University of Calgary, Libin Cardiovascular Institute, BHSc Health Sciences Editors: Romina Garcia de leon & Shayda Swann (Blog Co-coordinators)

Published: December 2nd, 2022

Note: When using the term ‘woman’ in this blog, it is to remain consistent with terms used in published literature. While ‘female’ refers to biological sex and ‘woman’ refers to gender identity, much of the medical literature currently reports findings on ‘women’ from samples of female participants. 

What comes to mind if I asked you to name a few risk factors for heart disease? Smoking? Obesity? Diabetes? What about in-vitro fertilization? 

In-vitro fertilization (IVF), a form of assisted reproductive technology, has risen in popularity since its first successful cycle in 1978. Currently responsible for approximately 2% of live births in Canada, IVF is a source of hope for families struggling with biological and/or social infertility. Biological infertility is the inability to achieve pregnancy after one year of unprotected sex and implies a sexual relationship between a male and a female, whereas social infertility applies to those who cannot conceive through intercourse due to factors related to sexual orientation.

Recent studies demonstrate that females treated with IVF may have increased cardiovascular risk compared to those who conceived naturally. The underlying mechanism of this association has not yet been determined, but it is critical to investigate to optimize patient care for females undergoing IVF treatment. But before we dig any deeper into this, we must first examine female cardiovascular disease.

Female cardiovascular disease: an overlooked and under-researched issue

Cardiovascular disease is the leading cause of death in women (shocking – I know!), yet women with cardiovascular disease remain underdiagnosed, undertreated, and undersupported. Research shows that heart attack signs are missed in more than 75% of women. Sex differences exist in mortality rates as well; after experiencing a heart attack, women have a higher chance of dying than men. 

But despite the risk of cardiovascular disease being similar between males and females, less than half of women are actually aware of their risk.

You would hope this would mean that both sexes would be equally represented in cardiovascular research, right? Unfortunately, not. Female systems and women have been historically under-represented in cardiovascular disease research, from the cellular level to animal research and human clinical trials.

Female sex- and gender-specific factors in cardiovascular health

We are now beginning to uncover that sex differences exist in the risk factors, presentation, progression and response to treatment in cardiovascular disease. An important identified contributor to these differences is sex hormones. Female sex hormones are known to directly interact with the cardiovascular system, and consequently, we see cardiovascular implications of experiences unique to females. Specifically, female sex hormones involved in menstruation, menopause, fertility and pregnancy all affect an individual’s cardiovascular risk. Furthermore, exogenous hormone administration, such as hormonal contraception or hormone replacement therapy, influences the development of cardiovascular disease and risk factors. When considering health determinants that disproportionately burden females, such as socioeconomic status and stress levels, it becomes clear that we must examine the sex and gendered factors related to female cardiovascular disease much more closely.

What happens to female sex hormones in IVF?

During IVF, female patients are treated with high doses of female sex hormones to stimulate their ovaries and promote the development of their eggs. This is called ovarian stimulation and is necessary for the subsequent steps of IVF, including egg retrieval, fertilization with sperm, and transfer of the embryo into a uterus to begin pregnancy. Many female sex hormones increase substantially during ovarian stimulation; for example, estrogen levels can increase by over 20x!  

Where does IVF fit into cardiovascular health?

Given what we already know about female sex hormones and cardiovascular disease, it is reasonable to wonder how ovarian stimulation impacts cardiovascular health. However, this has not yet been adequately studied. While we must strive to empower and expand a range of female reproductive choices, it is also important that we consider their cardiovascular implications to protect all aspects of health. To address this critical knowledge gap, I have initiated a study designed to investigate the effect of ovarian stimulation on cardiovascular risk in females treated with IVF, under the supervision of Dr. Sandi Dumanski at the University of Calgary. Healthy, pre-menopausal females planning IVF treatment will be invited to participate in this study. We will monitor changes in their hormone levels and vascular health (predictors of cardiovascular disease) as they undergo ovarian stimulation. This work will provide foundational knowledge that will play a key role in optimizing the care of females treated with IVF.

Where do we go from here?

It cannot go without saying that IVF treatment has provided hope and care for millions of families worldwide and has undergone incredible advancements in past decades — remaining a promising option for those challenged with infertility. However, the implications of this important treatment on cardiovascular health have not yet been fully elucidated. In the era of personalized medicine, and with consideration of the effects of sex and gendered factors on health, it is critical that we investigate health within female-specific contexts like IVF. I believe it is important that healthcare providers and scientists have (and use!) the tools to paint a clearer picture of unique female experiences so they can better inform the reproductive and lifestyle choices of females everywhere.

Behind the Science with Cindy Kalenga

Authors: Arrthy Thayaparan and Alex Lukey (Blog Coordinators) || Interviewing: Cindy Kalenga, BSc, PhD/MD candidate, University of Calgary

Published: July 26th, 2021

Pursuing women’s health was a no-brainer for Cindy Kalenga. Finding answers to concerns faced by the women in her life, her community, and even by herself was the obvious choice when she decided on her path as a M.D./Ph.D. candidate at the University of Calgary’s Cumming School of Medicine. 

For this month’s Behind the Science, we speak with Cindy to learn more about her research journey as a future leader in women’s cardiovascular health and as an advocate for the inclusion of minorities in the sciences.

How did you become interested in the sciences and the work you do now?

I think I’ve always had an interest in science, I completed my undergraduate degree in biomedical science at York University. I then moved to Calgary where I started working for the Primary Care Network assisting family physicians with chronic disease management. I focused mainly on things like diabetes, hypertension and mental health. 

After working for a year, I decided to pursue a graduate degree. I was interested in cardiovascular sciences as it had some overlap with my previous work. I ended up finding my research supervisor, Dr. Sofia Ahmed who investigated female-specific cardiovascular risk factors which I thought was really interesting!

Why women’s health?

When I was introduced to research, I noticed a huge disparity in studies that included females. Two thirds of clinical research is conducted in males and applied to both sexes; as you can imagine, some treatment strategies don’t completely translate over. 

When we look even further at research among racialized minorities such as a black women, the data is very scarce. So a lot of my interest and passion stemmed from advocacy within women and racialized minorities as this is an opportunity to better support the health of Canadians and people globally. 

What have you found through your research?

My research investigates the use of exogenous estrogen and cardiovascular markers among women. In young women, we investigate birth control use and in post-menopausal women, we study hormone therapy. Our preliminary data indicates that oral uses of estrogen may be associated with stiffer arteries and potential increases in risk for future cardiovascular risk. 

This data is very important as women ingest these hormones for many years, even several decades, and so any incremental increases in cardiovascular risk may have important impacts down the line. My research provides women and healthcare professionals the information they need to make informed decisions about treatment strategies. 

More longitudinal studies are required before we can make recommendations to clinical practice, however, our results suggest that women should opt for non-oral forms of birth control and estrogen therapy whenever possible, as this may be associated with lower cardiovascular risk. 

Do you think there is enough minority representation in the sciences?

I think we all know what the answer to that is; no there’s not enough representation. 

As a black woman pursuing a combined M.D. and Ph.D. degree, I have encountered very few minorities in leadership positions or as professors within my educational training. Representation is very important as it brings new ideas to the table and helps combat racial bias. 

The lack of representation also impacts the amount of research that’s done in that community. Often researchers are motivated to advocate for diseases that they’ve personally experienced or seen within their family and communities. So, if you don’t have enough black researchers there’s not enough people studying topics that predominantly impact black people. They also have the cultural competency needed to engage with their own community and mobilize them to participate in research. 

For instance, there are alarming racial differences in the material mortality rates. Black women are between 2 to 6 times more likely to die from complications during pregnancy compared to their white counterparts. Furthermore, black women are more likely to develop breast cancer at a younger age and it tends to be more aggressive. 

You can see how advantageous it is to have researchers who feel personally impacted by these statistics as it would motivate them to investigate this further. I’m interested in women’s health and that of racialized minorities, because that’s me, that’s my sister, those are my family members. 

On a final note, what do you hope for the future of your industry?

It’s always important to recognize the good work done by those who came before us. Whether that work was done only in males, we have developed ground breaking treatment strategies because of it. What I’m proposing is that research be expanded to other communities to foster innovation and better health outcomes for all Canadians. 

It’s always about providing racialized minorities a seat at the table. Finding novel ways to encourage minorities to pursue careers in research and medicine as well participate in research studies is the goal.