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In 2003, Bonnie Eckert delivered her firstborn, a daughter, after a tough pregnancy that ended abruptly at 36 weeks when she developed HELLP Syndrome. This potentially fatal complication is often considered a variant of preeclampsia characterized by hemolysis, elevated liver enzymes and a low platelet count.

Feeling extremely unwell, with her blood pressure soaring and her liver “breaking down,” Eckert went to the hospital where labour was induced. Several hours later, she and her husband had their baby girl and were relieved to put the incident behind them, understanding that the “cure” for HELLP Syndrome was delivery. What Eckert didn’t know is that the condition had caused hidden damage to her cardiovascular system that increased her risk of developing heart problems.

On Dec. 20, 2016, Eckert, then 42 years old, woke up with a strange sensation in her chest. But she ignored the warning signs thinking things would improve.

Over the course of the day, Eckert developed chest pain that she just couldn’t ignore. She went to the emergency department where her heart was shocked to put it back into normal rhythm, and she was sent home. However, she was left with ongoing chest pain, extreme fatigue and exercise intolerance, and getting to the bottom of the problem proved to be a challenge.

Despite repeated visits to health-care providers, Eckert felt her concerns were being oversimplified and explained away. She was told things were normal, and felt she should be reassured, but her symptoms were still present.  

I didn’t feel taken seriously at all. I wanted to know why this happened.

A year later she was treated for arrhythmia, but still struggled to deal with her pain and exercise intolerance.

It wasn’t until she heard a talk by Dr. Kara Nerenberg, MD, a Libin Cardiovascular Institute physician and researcher who specializes in hypertensive issues in pregnancy, that she learned HELLP Syndrome sufferers are twice as likely to develop arrhythmias and other cardiovascular concerns. 

“My jaw dropped. I thought, ‘She is describing me,’” says Eckert of hearing the presentation. “I was relieved that someone finally pointed out something that helped with the explanation.”

Women more likely to be misdiagnosed

It proved to be a turning point for Eckert, who at 45 still has heart issues, but feels more in control now that she knows why she developed them and how she can safely exercise to regain her strength and stamina. 

Eckert’s experience with the medical system is frustratingly common. Despite the fact that cardiovascular disease is the leading cause of death for both men and women in Canada, women are more likely to be misdiagnosed, as they may present differently than men. As well, a number of treatments are based on research conducted solely on males, with little consideration for the unique aspects of female biology, like pregnancy and menopause.

Members of CV&Me, a Libin program that focuses on incorporating sex and gender considerations into cardiovascular health research and care, are working to change that. The group is being recognized for its efforts. 

The ����ɫ�� recognized CV&Me with a 2020 Diversity Award for outstanding commitment and excellence to equity, diversity and inclusion at a special awards ceremony on Jan. 28.

CV&Me works to improve people's health through knowledge

Dr. Sofia Ahmed, MD, a kidney doctor and researcher, is the lead of the group, made up of about 45 researchers and trainees from a wide range of disciplines, from population health to biomedical and clinical research. Members of the group are working hard to incorporate biological sex and sociocultural gender considerations into all aspects of cardiovascular research and clinical care.

“The goal is to improve people’s health through knowledge,” says Ahmed of the initiative, which kicked off in 2019. “One size doesn’t fit all.”

Ahmed is one of Canada’s leading experts in sex and gender considerations in health research who became interested in the topic while involved in a research project during medical school.

Her ‘aha’ moment came when she asked her mentor why they were only studying male participants in their research and was told that including females was difficult because of the changes in their menstrual cycles. Ahmed decided that although it may be more complex to study females, it was a critical undertaking.

Ahmed is pleased CV&Me was recognized by the University.

“We are so proud of our work,” she says. “We have come a long way.”

Sex and gender are important aspects 

The Libin Institute’s Research Director, Dr. Robert Rose, PhD, is also a member of CV&Me. His lab is dedicated to identifying sex differences by using both male and female animals in their studies of cardiac disease and analyzing both sexes separately to determine sex differences when they exist.

Rose is proud of the efforts of CV&Me and believes the program will be key to tailoring treatments for patients to improve outcomes. 

“Sex and gender is an aspect of personalized medicine, and I see us being at the forefront of this movement as the years go on,” he says. “Through our efforts I envision a future where sex and gender considerations will become the standard approach.”

CV&Me members not only focus on incorporating sex and gender considerations in the design and implementation of their research, but they are also interested in educating the next generation of clinicians and researchers on how to incorporate these considerations into their own projects and practice.

Symposium, community outreach raise awareness 

In fact, the group organized a trainee symposium on the topic in early February. Held in Banff, the Libin International Trainee Symposium: Research is Better with Sex and Gender! attracted 75 trainees from across Canada and the Netherlands. Trainees heard from visiting experts in the field and were mentored by CV&Me members in similar scientific disciplines on how to incorporate sex and gender into every aspect of their own research projects — from the design stage to publication.

In addition, CV&Me is raising awareness about women’s cardiovascular health through community outreach events.

The group is also working to incorporate gender – which encompasses everything from cultural roles to socially constructed or institutionalized identity — into research.

Ahmed says it’s an important consideration with a number of potential impacts. For example, women tend to take longer to seek medical attention for a heart attack, and are less likely to take part in research studies, but researchers aren’t sure why.

Patient-centred approach

Another emerging area is how gender-affirming therapy can affect cardiovascular health outcomes. It is another important consideration because gender-diverse people are disproportionately impacted by cardiovascular disease.

“The whole point is taking care of the person in front of you optimally, and you need to factor all of these considerations in,” says Ahmed.

Libin Director Dr. Paul Fedak, MD, PhD, is proud of the group’s patient-centred, inclusive approach to research and health care. He is excited by the group’s ability to collaborate across a diverse range of disciplines.

“Clinicians and researchers within the institute have a unique opportunity to work together to improve care for individual patients,” he says. “By integrating research and clinical care, we can solve real clinical problems. CV&Me is an excellent example of the power of collaboration and the Libin Cardiovascular Institute is proud of its successes.”

Kara Nerenberg is an associate professor, departments of Medicine, Obstetrics and Gynaecology, and Community Health Sciences and a member of the Libin Cardiovascular Institute and the O’Brien Institute for Public Health at the Cumming School of Medicine.

Sofia Ahmed is a professor in the Department of Medicine and a member of Libin Cardiovascular Institute and the O’Brien Institute for Public Health at the Cumming School of Medicine. 

Robert Rose is a professor in the departments of Cardiac Sciences and Physiology and Pharmacology and a member of the Libin Cardiovascular Institute at the Cumming School of Medicine.

Paul Fedak is the head of the Department of Cardiac Sciences and a professor in the Department of Surgery and a member of the Libin Cardiovascular Institute at the Cumming School of Medicine.