Dr. Sarrel shares how the study of heart disease in women has changed over time.
Let me introduce myself. My name is Dr. Philip Sarrel. I am a member of EmpowHER’s Medical Advisory Board. I work at Yale University. I have been at Yale University for over 40 years. In my work at the university I have focused on two very important areas, one area is human sexuality and the other area is women’s health in midlife and aging.
Since 1976 we have had a midlife study program for women at Yale University and I have been the Director of that program. As a result of working in the program I have become aware of a number of different issues that are very important to the women we have seen.
So we have seen thousands of women for many thousands of office visits, and fortunately because I am also a professor of psychiatry, as well as obstetrics and gynecology, I have been able to have the time to listen and understand the meaning of things to the women. That’s been very important.
Concern about heart disease is one of the most, if not the most important topic, that has come up in all of this experience. It was such an important topic that by the late 1980s I was studying how hormones, women’s hormones, affect how arteries work, and doing basic research and publishing papers about the actions of hormones like estrogen and like progesterone, and how much they were affecting blood flow could actually go through a vessel.
The result of that work and the publications was that I was able to obtain a position at the National Heart and Lung Institute in London, which is their primary research heart institute, and work there for an entire year doing basic research of how hormones work on the cells that control arteries, and also in women with heart disease and ways in which hormones could help them or hurt them.
Talking about women’s heart disease and how it relates to women’s health in general I think is a very interesting story and it’s a very important story for today’s women. This is not just a story of the past; it’s a story of the present and the future.
There was a very long period of time in which it was believed by the people in medicine and the research scientists that women did not develop heart disease. It’s all based on a single publication in the year 1801. There was a study done by a pathologist named Heberdon, and published in London and it was a study of 100 patients who had died of a heart attack – 97 were men and three were women.
As a result of those findings, the author, one of the most respected people in the history of medicine, and every doctor knows that name – Heberdon - that also concluded that heart disease was a disease of men; that it was extremely rare in women.
It’s very interesting then to see almost a hundred years later a man named Osler who was called the ‘Father of Modern Medicine’, the professor of medicine at Johns Hopkins and later at Oxford University, gives a lecture to Johns Hopkins medical student in which he describes the problem with chest pain in women, but he concludes it can’t be due to their heart because we all know that women don’t have heart disease.
You see how a belief can cloud the true picture, and these beliefs can last for a very long time. Changing those beliefs and bringing them up-to-date with the facts is almost like turning around a trans-Atlantic ocean liner. That’s how difficult it can be.
I think that’s true for a lot of issues in women’s health today, that women will have conditions that are very real, affecting their lives, affecting mortality. They will present them for help but not get listened to because the medical belief, as you might have guessed, William Osler said, since the women can’t have a heart condition, he coined the term ‘neurotic angina’.
And in fact, there’s a whole literature in the psychological literature and the psychiatry literature on neurotic angina, and there probably are some men and some women who get chest pain and it’s in their head and not in their hearts, but the fact of the matter is that for most women who have the real symptoms that come from the heart not getting enough oxygen is due to very real changes in their body’s function.
But starting in the middle of the 20th century, so by the 1950s, it started to become clear that indeed women had coronary artery disease that would lead to a heart attack and that it was more often seen in women than in men. This was worked on at the Mayo Clinics, and it was also related to the loss of their ovaries.
So the papers from the Mayo Clinic showed us by late 1950s or early 1950s that the most severe coronary artery disease was seen in a woman at autopsy, was seen in a woman who had lost her ovaries and never received replacement of the missing hormones.
In today’s society, now we are in the 21st century. We are not at the beginnings, you know back in 1800; we are 200 years later. The fact of the matter is that more women die each year in the United States of a heart attack than men.
Okay, maybe all of you know that but a very recent study of physicians in this country found, only 20% of doctors know that fact. They still believe that heart disease is a problem of men and not of women. They know women die of heart attacks but they don’t know more women than men.
It means that they need advocates like myself and others who are thought leaders in the field of medicine but they also need leaders among the basic researchers and they need leaders among the women themselves.
If you have a belief system, remember the doctors not knowing that the women die more often than men, how often in the United States alone, you know, we are all so concerned about breast cancer and we should be, every year in the United States 40,000 women die as a result of breast cancer, but what most people don’t know is that 400,000 women die of a heart attack.
The image that we have, and here’s another major issue of consciousness raising, the image we have is the woman who dies of a heart attack is 88 years old and it’s the end of her life and she has a heart attack and she dies.
Well, it is true that in women in their 80s you have the highest incidents but, of those 400,000 women each year or of all the women having a heart attack each year, 14% of them are women still having menstrual cycles. These are all women under the age of 50 who are having a heart attack secondary to changes in their body’s hormones complicated by the factor of smoking.
So we need to talk about a lot of different issues because a lot of them are lifestyle issues that women can do something about to prevent this, but the first issue to raise is heart attacks can affect women from their late 20s, early 30s, all the way through the rest of their lives; not necessarily their grandmothers, it could be themselves.
About Dr. Sarrel, M.D.:
Philip M. Sarrel, M.D., completed his medical education at New York University School of Medicine, his internship at the Mount Sinai Hospital, and his residency at Yale New Haven Hospital. In addition to his many years on the faculty of the Departments of Obstetrics and Gynecology and Psychiatry at Yale University School of Medicine, Dr. Sarrel has also been a Faculty Scholar in the department of psychiatry at Oxford University, Visiting Senior Lecturer at King’s College Hospital Medical School at the University of London, Visiting Professor in Cardiac Medicine at the National Heart and Lung Institute in London, and Visiting Professor in the Department of Medicine at Columbia University College of Physicians and Surgeons in New York. He is currently Emeritus Professor of obstetrics, gynecology, and psychiatry at Yale University.