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Heart research genetics & equity: Women under-represented in studies

Updated: Jan 26, 2023

Women are more likely to have a heart attack, yet they are the minority in heart research. Māori women even more so. That is something Auckland researcher Dr Nikki Earle wants to address.

The Auckland Medical Research Foundation postdoctoral fellow is conducting a longitudinal study of more than 2000 New Zealanders who have survived their first heart attack. The aim is to develop ways to identify people at highest risk of death or re-hospitalisation and intervene with more personalised treatments.

The majority of those who have been recruited on to the study so far are males, so Nikki, the recipient of the AMRF Douglas Goodfellow Postdoctoral Fellowship, wants to expand the cohort to be more representative of the population.

“Historically, heart research studies have included more men than women, meaning that heart disease in women has not been as well investigated,” Nikki explains.

“We have 2015 people enrolled, and our work will now focus on filling equity gaps. This will help us to better understand how heart attacks manifest differently in women compared with men, and to identify risk markers for subsequent events that are specific to women.

Women made up one fifth of the initial cohort, with the risk of death from any cause or cardiovascular readmission higher in women than men—26.7 percent vs 19.6 percent—and highest overall for Māori women at 31.1 percent.

Our work may lead to more personalised and better targeted treatments, and more equitable health outcomes for women with heart disease in New Zealand.

As treatments improve over time, more people are surviving events such as heart attacks. Currently more than 186,000 people in New Zealand have some form of heart condition, and are then at high risk of further events.

The Multi Ethnic New Zealand study of Acute Coronary Syndromes (MENZACS) is an ongoing multi-centre, longitudinal cohort study aiming to explore how environmental and genetic factors contribute to acute coronary syndromes in New Zealand’s ethnically-diverse population.

Extensive clinical and research data is collected from patients at 11 hospital coronary care units across the country during their first admission, along with a blood sample. Those blood results will measure biomarkers including genetic markers of heart disease risk, as well as known clinical and environmental cardiovascular risk factors such as nutrition, stress, and physical activity.

“Women have been so understudied. Things like premature menopause, having gestational diabetes when pregnant, or having any sort of high blood pressure problems when you're pregnant can increase your risk of cardiovascular disease, but so few women have been in any of these studies,” she explains.

“We're trying to double the number of women we have enrolled, so we end up with 800 women and we’re aiming to enrol another 250 Māori. Because we're looking at people when they've had their first event it can take a number of years for these subsequent things to happen, so it really is a long term game.”

Patients remain anonymous and do not need to participate other than provide their medical history along with any family history of heart disease and lifestyle behaviours (nutrition and exercise details, work stress etc) and allow on-going access to their medical records, stored under their National Health Identifier number.

“We can look at things like how you respond to different medications based on your genetics, whether people are receiving the best medication for them while they've been in hospital and afterwards. With time, the data set becomes more valuable.”

Nikki has been funded by AMRF on several occasions: in addition to supporting her PhD from 2012 to 2015 with a doctoral scholarship, Nikki has been awarded two AMRF project

grants as well as the postdoctoral fellowship.

The quality of her work and the promise of her career meant she was also awarded an Emerging Researcher Start-Up Award from AMRF's partnership with the Kelliher Charitable Trust.

I don't know what I would be doing if I didn't get this fellowship

“This funding gives me peace of mind that I can continue this valuable work.”

Hear Dr Nikki Earle and Prof Julian Paton describe their cardiovascular research from the laboratory bench to the cardio clinic . Watch it now!


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