New scoring system could help determine women’s risks

By Staff 8 Min Read

  • Researchers are recommending an upgrade in a widely used scoring system to ensure better heart disease diagnosis in women.
  • The researchers suggest leveraging big data and incorporating machine learning to improve the Framingham Risk Score system.
  • Experts say medical professionals as well as women themselves tend to ignore cardiovascular disease symptoms in females.

The scoring system used to predict a person’s risk of cardiovascular disease needs to get an upgrade to ensure it accounts for risk factors specifically affecting women, according to a study published today in the journal Frontiers in Physiology.

The Framingham Risk Score (FRS) analyzes six factors to determine a person’s likelihood of experiencing a heart attack or stroke within the next 10 years. The six factors are age, gender, diabetes, cholesterol, smoking habits, and blood pressure.

While the system does account for gender, researchers say it has never considered the more specific factors within the female body that significantly affect their risk of heart attack or stroke.

“Anatomically, female and male hearts are different,” the study authors wrote. “For example, female hearts are smaller and have thinner walls. Yet, the diagnostic criteria for certain heart diseases are the same for women and men, meaning that women’s hearts must increase disproportionally more than men’s before the same risk criteria are met.”

The researchers said the current design of the FRS means multiple cardiovascular conditions are overlooked and consequently under-diagnosed in women.

“When it comes to cardiovascular diseases in particular, the prevalence of these diseases is higher in men than women, but several studies have shown that women are less likely to be diagnosed during a routine exam, get diagnosed at an older age, and with more severe symptoms than men,” Skyler St. Pierre, a study author and a researcher at the Stanford University Living Matter Lab in California, told Medical News Today. “This really points to the fact that we are under-diagnosing women and the current screening methods are not catching women with cardiovascular diseases early enough.”

The researchers suggest leveraging large data sets as well as incorporating machine learning into the FRS to help improve the diagnosis for women.

Medical research has been criticized in the past for collecting data on a specific condition or medication, and then generalizing the results to women.

“The lack of sex-specific diagnostic criteria is a major contributor to why this is happening,” said St. Pierre, “but other factors like medical misogyny and lack of awareness for the different symptoms that women may exhibit compared to men can’t be ignored either.”

“Women are not just small men,” said Dr. Evelina Grayver, a cardiologist and director of Women’s Heart Health at Central Region Northwell Health in New York who wasn’t involved in the study.

“We’re so different, physiologically and anatomically. Unless we have specific studies like this, women will always be under-treated and under-represented in the world of cardiovascular health,” Grayver told Medical News Today.

Heart disease kills more women each year than all cancers combined — yet experts say misconceptions continue to portray heart attacks as a risk primarily in men.

“In the movies and real life, when a man clutches his chest, we assume he’s having a heart attack,” said Grayver. “When a woman clutches her chest, we assume it’s a panic attack.”

These perpetuated misconceptions can mean that even women do not believe they are at risk for a heart attack.

“Women tend to delay how quickly they go to the emergency room when they’re experiencing a heart attack,” said Grayver. “When they finally go to the hospital, they’ll face bias from healthcare professionals next. Their symptoms might be dismissed as indigestion or anxiety.”

In men, heart attack symptoms commonly result in chest and arm pain, chest tightness, and the feeling of an “elephant sitting on your chest.”

In women, the symptoms are often different: shortness of breath, reflux, nausea, vomiting, and a sensation that your bra might suddenly feel too tight.

Dismissing these subtler symptoms means delaying critical treatment.

“During a heart attack, time equals muscle damage,” said Grayver. “The more time that passes, the more damage that occurs, putting women at a higher risk of having significant complications from a heart attack.”

“I’m excited there’s finally a consideration that our calculators are not accounting for the risk factors that affect a woman’s risk of heart attack,” said Grayver. “All of these calculators were based on data extrapolated on research from white men.”

Grayver points to a variety of non-traditional risk factors that play a significant role in a woman’s heart health: estrogen levels, pregnancy complications, autoimmune diseases, family history, depression, and even breast tissue can all be indicators of heart attack risk.

“Estrogen protects your heart,” explained Grayver, adding that estrogen relaxes your arteries and promotes the production of “good” HDL cholesterol.

“But estrogen levels drop significantly during menopause and research has already determined that this takes a toll on the heart,” Grayver noted.

“When a woman loses that estrogen, she faces a higher risk of developing other conditions, like diabetes, obesity, high cholesterol, and heart disease,” she added. “There’s not a single calculator that takes these into account.”

Grayver said complications during pregnancy, such as preeclampsia and gestational diabetes, also reveal a woman’s risk of experiencing a heart attack, but these details are not routinely considered in cardiology.

“I would also love to see a risk score that takes into account a woman’s breast calcium score because research has found an association between breast calcification and predisposition to cardiovascular disease,” said Grayver.

Grayver believes mammogram results should be part of the discussion when reviewing a woman’s overall health, especially her heart.

“At age 40, women are already encouraged to get routine mammograms and breast exams, but they don’t know when they should start seeing a cardiologist,” added Grayver. “This conversation should start at the same time as mammograms, and it could lead to getting earlier cardiovascular support.”

Grayver hopes this gender-specific evolution within the FRS helps to shift how society and healthcare professionals think about a woman’s risk of a heart attack.

“Do not dismiss a woman’s symptoms,” stressed Grayver. “Do not assume it’s anxiety. There should never be a cookie-cutter approach for any patient. Improving the Framingham Risk Score will pave the way for new types of medicine and better healthcare.”

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