Cardiologists appeal, 'women's health goes beyond the bikini area'

American cardiologist Nanette Wenger called it the “bikini approach to women's health” to define the tendency to address female diseases by focusing on the breasts and reproductive system. The costume area, in fact. It's time to go further, is the appeal of the cardiologists who will gather in Milan on April 19th for the Monzino Forum 'Clinical research and cardiovascular diseases in women'. At the center of the work is “the gender gap in the treatment of heart diseases”, explain the Milanese IRCCS. Suffice it to say that “the dosage of all heart drugs is calculated for a young male weighing 70 kg, ignoring the specificities of women, who are represented in less than 40% of clinical pharmacological studies”.

“It is urgent to revolutionize this approach”, says Daniela Trabattoni, head of the Coronary Interventional Cardiology and Heart Defects Operational Unit and head of the Monzino Women Heart Center. “Gender medicine – he specifies – is not a one-size-fits-all medicine, but a transversal approach that must take into account biological differences (defined by sex), socio-economic differences (defined by gender) and the specificity of each person. In the cardiovascular field – highlights the specialist – the absence of gender medicine has created serious problems, starting from pharmacological treatments. Examining over 20 thousand clinical studies carried out between 1993 and 1997, we found a sensational shortage of female participants and therefore of data on women. women. The situation has not changed over the years: in studies between 2010 and 2017, women were not represented by more than 39%”.

In concrete terms, Trabattoni clarifies, “this means that women are often under-treated because the drugs commonly used for major cardiovascular diseases, starting from heart attacks, being administered in effective doses in men, can cause important side effects in women and consequent poor adherence to therapy. The mechanisms of drug absorption in women can also be different from men”, the expert points out. “For example, aspirin is eliminated more rapidly from the female body because it has a shorter half-life, while paracetamol is eliminated more slowly. For this reason, following the standard dosage, women often make greater use of anti-inflammatories for migraines or menstrual pain, they are more likely to overdose on anti-inflammatories.” It is no coincidence that “71% of patients who enter the emergency room due to drug abuse are women”.

“There is an obvious need to promote more and more non-profit clinical studies aimed at evaluating the actual benefit/risk profile of many drugs currently commonly used in females”, underlines Marco Scatigna, director of the Monzino Clinical Trial Unit.

“Women, however, are not destined to remain the Cinderellas of cardiology”, assures Trabattoni. “We have the tools to arrive at a tailor-made cure for female heart diseases. It's about raising awareness and spreading knowledge and approaches and Monzino – recalls the specialist – has played a pioneering role in this direction with the opening, already in 2016, of the Monzino Women Heart Center, the first clinical and research structure dedicated to female cardiology”.

“The horizon – concludes the head of the center – is also opening up at the level of the careers of women cardiologists, an essential factor for the development of gender cardiology. Today, out of 20,564 cardiologists, 14,505 are men and 6,054 women, with only 3 women versus 54 men in top positions. In the new generations of doctors the situation has changed: in the 30-45 age group there are 2,416 women, while 1,926 men”.

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