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To Understand Sex Differences in Alzheimer’s Disease, We Need to Understand Risk Factors Across the Lifespan

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By Elizabeth Mormino, PhD, Stanford University, SWHR Interdisciplinary Network on Alzheimer’s Disease Member

The long course of Alzheimer’s disease: Put simply, Alzheimer’s disease (AD) can be conceptualized as two stages: a clinically silent stage, where brain pathologies are present, but symptoms are absent; and a symptomatic stage, where individuals show signs of dementia (this typically involves memory impairment as well as an inability to live independently). Although there is debate regarding what criteria should be used to classify the clinically silent stage, there is consensus in the field that the pathological drivers of AD, the brain accumulation of amyloid and tau proteins, begin decades before symptoms occur. We can measure these pathologies in humans by using either brain scans or lumbar puncture. Research studies have shown that individuals with no symptoms of dementia but who have evidence of AD pathology are at elevated risk for being diagnosed with AD during a later follow-up visit [1]. These individuals with evidence of pathology but no symptoms are currently being targeted in prevention trials to determine if reducing pathology during the clinically silent stage prevents symptoms of dementia [2]. Given the failure of multiple clinical trials in symptomatic AD patients, there is hope that targeting the disease as early as possible, even before symptoms are present, will be a successful strategy against AD.

 

Risk factors for AD: Despite the fact that over 5 million Americans currently live with AD, it is very difficult to predict who will develop the disease. The most established risk factors are older age and the presence of the APOE4 gene (possession of the APOE4 genotype is known to increase amyloid buildup in the brain). Interestingly, some work has suggested that women are more at risk for AD than men, even after accounting for women’s longer lifespans. However, a greater incidence of AD is not always identified in studies [3], suggesting that if women are at elevated risk of AD compared to men, the reasons are complex and multifactorial.

 

Importance of sex-specific risk factors for AD across the lifespan: Regardless of whether women are at greater risk for AD, there are undoubtedly different sets of risk factors that impact women versus men. Importantly, these factors are likely to exert changes at different points in the lifespan, which is particularly relevant when considering how sex-specific risk factors may interact with AD pathologies (see Figure). For instance, many factors that show sex differences, such as education during early life, hormonal changes, and vascular changes influence risk of dementia. It is therefore possible that these risk factors that act differently in women and men interact with AD pathological events at different points along the lifespan to ultimately influence risk of AD in late life. For instance, brain accumulation of amyloid and tau proteins are present in midlife [4] and may interact with risk factors that are different in women and men during that portion of the lifespansuch as menopause. The interaction between risk factors, AD pathology, and sex in midlife may be particularly true for women that possess the APOE4 risk gene, since APOE4 is known to shift the age of amyloid buildup earlier (see Figure).

 

Goal of early identification and prevention: With the recent ability of scientists to measure amyloid and tau accumulation in living people [5], there is a unique opportunity to understand AD pathology throughout the lifespan and before symptoms are present. With these tools, we should aim to develop algorithms that predict future risk, and design treatment strategies that prevent the symptomatic stage of AD altogether. In this pursuit, and because of their known influence, consideration of sex-specific factors that influence AD pathologies is essential to the goal of early identification and prevention of the disease.

ALTZ_PrevFigure: Summary of time course of AD pathologies across the lifespan. Amyloid accumulation occurs at earlier ages in individuals with the APOE4 genotype (purple line compared to orange line). Tau accumulation in brain regions essential for memory are common in middle age (green line). Examples of sex-related differences throughout the lifespan are superimposed (blue, yellow, and pink rectangles), and show different degrees of overlap with the occurrence of pathological processes.

 

There is still more to be done in investigating new AD risk factors and discerning how established risk factors vary by sex and gender. The Society for Women’s Health Research Interdisciplinary Network on Alzheimer’s Disease is committed to advocating for these goals in order to inform prevention and treatment, providing guidance for research, clinical trials, and policy. Click here to learn more about our work.

 

 

References

  1. Rowe, C.C., et al., Predicting Alzheimer disease with beta-amyloid imaging: results from the Australian imaging, biomarkers, and lifestyle study of ageing. Ann Neurol, 2013. 74(6): p. 905-13.
  2. Sperling, R.A., et al., The A4 study: stopping AD before symptoms begin? Sci Transl Med, 2014. 6(228): p. 228fs13.
  3. Mielke, M.M., P. Vemuri, and W.A. Rocca, Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences. Clin Epidemiol, 2014. 6: p. 37-48.
  4. Braak, H. and E. Braak, Frequency of stages of Alzheimer-related lesions in different age categories. Neurobiol Aging, 1997. 18(4): p. 351-7.
  5. Johnson, K.A., et al., Tau positron emission tomographic imaging in aging and early Alzheimer disease. Ann Neurol, 2016. 79(1): p. 110-9.

 

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Menopause, Memory, and Alzheimer’s Disease

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By Pauline M. Maki, PhD, University of Illinois at Chicago, Society for Women’s Health Research Interdisciplinary Network on Alzheimer’s Disease Member
When women think about menopause, they typically think about hot flashes. New research shows that memory problems are a common but under-recognized menopausal symptom.

Memory problems emerge during perimenopause, the time around the final menstrual period, before many women even realize that they are “going through the change.” Early research studies have documented an increase in memory complaints, such as forgetting names, as a woman enters the menopausal transition, while more recent studies have revealed measurable changes in verbal memory as a woman transitions through menopause [1,2].
Although decreases in memory are a normal part of aging, age does not account for the changes in memory that occur when a woman transitions through menopause. Similarly, although sleep disturbances and mood symptoms are common and can affect memory, they do not account for memory problems during this transition. Preliminary research links memory problems to hot flashes, (when hot flashes are measured objectively- using ambulatory monitors) but further research on this issue is needed [3,4]. The good news is that memory problems that can emerge during perimenopause seem to improve during the postmenopausal years [2].

Hormonal factors appear to play a role in memory changes during the menopausal transition. The ovaries are the primary source of estrogen in premenopausal women. In women who have not yet reached their final menstrual period, having their ovaries surgically removed leads to a decline in verbal memory, which is reversed when they take estrogen therapy [5]. Similarly, removing ovaries before age 48 has been associated with a 70 percent increased risk of cognitive impairment or dementia [6], but use of estrogen therapy until the typical age of menopause negates that risk.

When women are in their 50s and have transitioned through menopause, taking hormones does not seem to affect memory performance. For example, memory does not change when women begin hormone therapy within five years after their final menstrual period [6,7]. Meanwhile, initiating hormone therapy later in life – after age 65 – can actually increase the risk of memory problems and dementia [8,9]. It might be that women with hot flashes particularly benefit from hormone therapy. Initial evidence indicates that hormone therapy can improve memory and brain function in women with moderate to severe hot flashes [10], but more extensive studies are needed. Similarly, it is unknown how taking birth control pills containing estrogen can influence memory in perimenopausal women.

Women show a lifelong advantage in verbal memory compared to men. Interestingly, this advantage might make it more difficult for clinicians to detect a memory problem in women who are in the early stages of Alzheimer’s disease (AD). Before developing AD, patients transition though a stage called amnestic mild cognitive impairment, or aMCI. At this stage, memory problems exceed what is expected for age but do not reach the level of severity seen in AD. The female advantage in verbal memory persists in the aMCI stage. Consequently, women perform better than men despite showing the same level of AD disease on brain scans [11-13]. Although this could be seen as an advantage, women may be diagnosed with aMCI or AD at a later and more severe stage of the disease than men. Researchers are now exploring whether it might be useful for clinicians to use different cut-offs for memory tests in women and men, so that AD can be detected earlier in women.

Together, these studies demonstrate the important need to address how brain aging differs between women and men. By examining how menopause, estrogen, and other factors contribute to those differences, we can improve efforts to prevent, detect, and treat memory problems, and memory disorders such as AD. This is especially relevant for women, who make-up 3.2 million out of the approximately 5 million individuals in the U.S. living with AD. It is estimated that the prevalence of AD will triple by 2050 [14], and the associated costs will exceed $20 trillion U.S. dollars. For this reason, it is imperative that we continue to work together to fund AD research and support studies that recognize and address the ways in which this deadly disease can affect women and men differently.

There is still more to be done in investigating new AD risk factors and discerning how established risk factors vary by sex and gender. The Society for Women’s Health Research’s Interdisciplinary Network on Alzheimer’s Disease is committed to advocating for these goals in order to inform prevention and treatment, providing guidance for research, clinical trials, and policy. Click here to learn more about SWHR’s work in Alzheimer’s disease.

References:

1. Epperson CN, Sammel MD, Freeman EW. Menopause effects on verbal memory: findings from a longitudinal community cohort. J Clin Endocrinol Metab. 2013;98(9):3829-38.
2. Greendale GA, Wight RG, Huang MH, Avis N, Gold EB, Joffe H, et al. Menopause-associated symptoms and cognitive performance: results from the study of women’s health across the nation. Am J Epidemiol. 2010;171(11):1214-24.
3. Drogos LL, Rubin LH, Geller SE, Banuvar S, Shulman LP, Maki PM. Objective cognitive performance is related to subjective memory complaints in midlife women with moderate to severe vasomotor symptoms. Menopause. 2013;20(12):1236-42.
4. Maki PM, Rubin LH, Savarese A, Drogos L, Shulman LP, Banuvar S, et al. Stellate ganglion blockade and verbal memory in midlife women: Evidence from a randomized trial. Maturitas. 2016;92:123-9.
5. Sherwin BB. Estrogen and/or androgen replacement therapy and cognitive functioning in surgically menopausal women. Psychoneuroendocrinology. 1988;13(4):345-57.
6. Henderson VW, St John JA, Hodis HN, McCleary CA, Stanczyk FZ, Shoupe D, et al. Cognitive effects of estradiol after menopause: A randomized trial of the timing hypothesis. Neurology. 2016;87(7):699-708.
7. Gleason CE, Dowling NM, Wharton W, Manson JE, Miller VM, Atwood CS, et al. Effects of Hormone Therapy on Cognition and Mood in Recently Postmenopausal Women: Findings from the Randomized, Controlled KEEPS-Cognitive and Affective Study. PLoS medicine. 2015;12(6):e1001833; discussion e.
8. Resnick SM, Maki PM, Rapp SR, Espeland MA, Brunner R, Coker LH, et al. Effects of combination estrogen plus progestin hormone treatment on cognition and affect. J Clin Endocrinol Metab. 2006;91(5):1802-10.
9. Shumaker SA, Legault C, Rapp SR, Thal L, Wallace RB, Ockene JK, et al. Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women’s Health Initiative Memory Study: a randomized controlled trial. JAMA. 2003;289(20):2651-62.
10. Joffe H, Hall JE, Gruber S, Sarmiento IA, Cohen LS, Yurgelun-Todd D, et al. Estrogen therapy selectively enhances prefrontal cognitive processes: a randomized, double-blind, placebo-controlled study with functional magnetic resonance imaging in perimenopausal and recently postmenopausal women. Menopause. 2006;13(3):411-22.
11. Sundermann EE, Biegon A, Rubin LH, Lipton RB, Mowrey W, Landau S, et al. Better verbal memory in women than men in MCI despite similar levels of hippocampal atrophy. Neurology. 2016.
12. Sundermann EE, Biegon A, Rubin LH, Lipton RB, Landau S, Maki PM, et al. Does the Female Advantage in Verbal Memory Contribute to Underestimating Alzheimer’s Disease Pathology in Women versus Men? J Alzheimers Dis. 2017;56(3):947-57.
13. Sundermann EE, Maki PM, Rubin LH, Lipton RB, Landau S, Biegon A, et al. Female advantage in verbal memory: Evidence of sex-specific cognitive reserve. Neurology. 2016;87(18):1916-24.
14. Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Archives of Neurology. 2003;60(8):1119-22.

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Obesity-related Eating Disorders in Women

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By: Anne McTiernan, MD, PhD, SWHR/Susan G. Komen Network for the Study of Exercise and Breast Cancer Member

In the U.S., more than four in ten women are obese, compared to a little more than a third of men [1]. Women are also more likely than men to experience discrimination about their weight [2]. For example, many women of size hear that if they exercised self-control, they would lose pounds easily. For many, it is just not that simple.

Weight-loss programs that involve reducing calorie intake and increasing physical activity produce an average 10 percent loss of starting weight within six months [3]. Weight-loss medications and bariatric surgery produce more dramatic results than calorie intake reduction alone. Ultimately, all weight-loss methods require significant behavior changes to alter eating patterns, and many people regain lost weight without ongoing support. Many women have difficulty making changes to their dietary choices. For them, eating can be uncontrollable and changing eating habits long-term, can seem impossible.

According to mental health experts, binge eating disorder is the combination of recurrent episodes of binge eating; a feeling of a loss of control during the binge; experiencing shame, distress or guilt afterward; and not using unhealthy compensatory measures to counter the binge eating [4]. This disorder is relatively rare, affecting about two in 100 individuals in their lifetimes [5], but is three times more likely to affect women than men [4]. Many more people engage in periodic binge eating without having a full-scale disorder.

The behavior of “eating when full” has significant consequences. Moments after an episode, the individual may experience gastrointestinal distress, nausea, and sometimes even vomiting. Psychological effects include feelings of embarrassment, self-disgust, depression, or guilt. Long-term binge eating also significantly increases the risk for excessive weight gain and obesity [6]. Studies have found that up to one in five women who are obese, struggle with episodes of binge eating [7]. An additional risk factor for obesity is emotional eating, which typically involves consumption of sweet, fatty, energy-dense foods in response to depression, anxiety, or anger. This type of emotional eating is a strong predictor of weight gain.

While both women and men can eat emotionally, women typically respond to negative emotions, while men eat in response to more positive emotions. Many researchers who study obesity believe that addiction to highly processed, hyper-palatable foods, could contribute to overeating and obesity. A compilation of research studies, including one with almost 200,000 people showed that one in four overweight or obese individuals have characteristics of food addiction and that women are twice as likely as men to have food addictions [8]. Furthermore, more than half of the people diagnosed with an eating disorder report symptoms consistent with food addiction.

Treating obesity in individuals with these eating issues can be complicated. Through diet and exercise, people with binge eating patterns can benefit from the same behavioral treatments as those who do not engage in binge eating. However, those who continue to binge eat lose less weight, and without long-term counseling, the disorder is likely to cause weight gain. Clinical trials are underway to test methods for treating people who engage in emotional eating [9]. Given the current epidemic of obesity, it is critical to develop and test new ways to prevent and treat obesity in people with challenges in controlling the type and amount of food that they eat.

Anne McTiernan, MD, PhD, conducts research on the effects of diet, exercise, and weight loss on cancer and health. Currently, she is faculty at the Fred Hutchinson Cancer Research Center and professor at the University of Washington Schools of Public Health and Medicine in Seattle, Washington. She is the author of Starved: A Nutrition Doctor’s Journey from Empty to Full (Central Recovery Press, November 2016).

References:

  1. Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL.Tr ends in Obesity Among Adults in the United States, 2005 to 2014. 2016 Jun 7;315(21):2284
  2. Spahlholz J, Baer N, König HH, Riedel-Heller SG, Luck-Sikorski C. Obesity and discrimination – a systematic review and meta-analysis of observational studies.Obes Rev. 2016 Jan;17(1):43-55.
  3. Butryn ML, Webb V, Wadden TA. Behavioral treatment of obesity. Psychiatr Clin North Am. 2011 Dec;34(4):841-59.
  4. Berkman ND, Brownley KA, Peat CM, Lohr KN, Cullen KE, Morgan LC, Bann CM, Wallace IF, Bulik CM. Management and Outcomes of Binge-Eating Disorder. Comparative Effectiveness Review No. 160. (Prepared by the RTI International–University of North Carolina Evidence-based Practice Center under Contract No. 290-2012-00008-I.) AHRQ Publication No. 15(16)-EHC030-EF. Rockville, MD: Agency for Healthcare Research and Quality; December 2015. effectivehealthcare.ahrq.gov/reports/final.cfm.
  5. Cossrow N, Pawaskar M, Witt EA, Ming EE, Victor TW, Herman BK, Wadden TA, Erder MH. Esti­­­mating the Prevalence of Binge Eating Disorder in a Community Sample From the United States: Comparing DSM-IV-TR and DSM-5 Criteria. J Clin Psychiatry. 2016 Aug;77(8):e968-74. doi: 10.4088/JCP.15m10059.
  6. Pacanowski CR, Senso MM, Oriogun K, Crain AL, Sherwood NE. Binge eating behavior and weight loss maintenance over a 2-year period. See comment in PubMed Commons below J Obes. 2014;2014:249315. doi: 10.1155/2014/249315. Epub 2014 May 8.
  7. Alessandro Leone, Giorgio Bedogni, Veronica Ponissi, Alberto Battezzati, Valentina Beggio, Paolo Magni, Massimiliano Ruscica and Simona Bertoli. Contribution of binge eating behaviour to cardiometabolic risk factors in subjects starting a weight loss or maintenance programme. British Journal of Nutrition (2016), 116, 1984–1992.
  8. Pursey KM, Stanwell P, Gearhardt AN, Collins CE, and Burrows TL. The prevalence of food addiction as assessed by the Yale Food Addiction Scale: a systematic review. Nutrients 2014, 6, 4552-4590
  9. Lillis J, Niemeier HM, Ross KM, Thomas JG, Leahey T, Unick J, Kendra KE, Wing Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial. BMC Psychol 2015; 3(1): 17.
Scared woman in bed

STDs are Incredibly Common – So Why The Stigma?

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By Natalia Gurevich, SWHR Communications Intern

Chlamydia, herpes, HIV – I could go on. I’m sure most of these terms sound familiar to the majority of people, especially those who are sexually active. By age 14, it’s a requirement in many schools that students take a comprehensive Sex Education course, so most of us received some form of the “birds and the bees” talk in a classroom – usually accompanied by the trials and tribulations of putting a condom on a banana. Around that age, sexually transmitted diseases (STDs) are discussed in Sex Education and methods of preventing them are emphasized. However, it’s not often that the stigma and social implications, in conjunction with the overall psychological implications of STDs, are discussed.

Prior to enrolling in a human sexuality course in college, I wasn’t aware of the social and psychological stigma attached to STDs. Around that time, it became apparent that there was a high prevalence of STDs within my age group and even within my social circle. These foreign terms I first learned about at the age of 14 weren’t so foreign after all. I realized that STDs affect a staggering of number of individuals in my age group, and that far too many people are afraid to open up about them, fearing social repercussion.

In 2015, the Centers for Disease Control and Prevention (CDC) reported that cases of three nationally prevalent STDs (gonorrhea, syphilis, and chlamydia) were rising rapidly [1]. Fifty percent of new infections occur in young people, ages 15-24, even though this demographic only represents a quarter of people who have had sex [2]. According to the American Sexual Health Association (ASHA), one in two people will contract an STD before the age of 25 [3]. This does not include the vast majority of individual cases which go unreported. Even though CDC reports reveal 110 million cases in the U.S. – about 50.5 million reported cases in men and 59.5 million cases in women [2] – it is likely that there are many more. Not only is there a high discrepancy in reported cases between men and women, STDs disproportionally affect women at a considerable rate. Ten to 20 percent of women infected with gonorrhea and chlamydia develop one of the most serious complications; pelvic inflammatory disease (PID). PID can lead to even more serious consequences, like infertility and potentially fatal ectopic pregnancy [4].

Despite recommendations from the CDC and the United States Preventive Services Task Force (USPSTF) for annual chlamydia and gonorrhea screening for sexually active women younger than 25, experts are concerned that not enough women get tested and therefore don’t know they are infected [1].

A great number of people who contract STDs remain undiagnosed, but those who have face a heavy burden afterward. Even though STDs are proven to be more common than many believe, particularly in young people, the stigma surrounding STDs still prevails. A lot of that stigma is associated with judgment and preconceived notions about sex. It can only take one partner to become infected. Sometimes, it doesn’t take any partner – infection can occur in all sorts of circumstances and contact. And because many STDs are asymptomatic, it’s important to get tested regularly. Without testing, diseases can be spread without individuals realizing it [5].

If you are under the age of 25 and infected, you are not alone. Learn more about what you can do to protect yourself and others at the Society for Women’s Health Research (SWHR®) website. Even if you aren’t infected now, there’s a possibility you might be later. SWHR believes that education and information about our bodies, especially for women, empowers us. If you aren’t sure about your STD status, contact your health care provider and find out what tests are available to you.

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SWHR Participates in Clinical Trials Education Event

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The Society for Women’s Health Research (SWHR®) participated in AWARE for All, a public education event hosted by the Center for Information and Study on Clinical Research Participation (CISCRP) earlier this year.

AWARE for All is a free, public educational program that provides information about clinical research participation and encourages the public to make educated decisions. The event, held at Howard University’s Armour J. Blackburn Center in Washington, D.C., consisted of free health checks and testing, a health fair, dinner, panel discussion, and Medical Heroes Appreciation Ceremony.

The panel discussion featured Dr. Jane Otado, Assoc. Director, Regulatory, Ethics, Knowledge & Support, Research Participant Advocate, GHUCCTS, College of Medicine, Community Health & Family Medicine, Howard University Hospital Cardiovascular Health; Dr. Otelio Randall, Professor of Medicine, Director of Preventive Cardiology, Howard University College of Medicine Oncology Research Focus; Dr. Mohamed Salem, Assistant Professor, Gastrointestinal Oncologist, Georgetown University, Lombardi Comprehensive Cancer Center Engaging Minority and Underserved Communities; Dr. Jonca Bull, Assistant Commissioner for Minority Health, Office of the Commissioner, FDA Mental Health Focus; Dr. Robert Miller, Senior Associate Dean for Research, Vivian Gill Distinguished Research Professor, Professor of Anatomy and Regenerative Biology, School of Medicine and Health Sciences, George Washington University.

The Medical Heroes Ceremony, moderated by Dr. Fabian Sandoval, CEO, Emerson Clinical Research Institute, celebrated individuals for their contributions to medical research.

SWHR tabled at the health fair, engaging with community members and highlighting the importance of including women at every stage of healthcare research. Other participating organizations at the health fair included the Arthritis Foundation, Bladder Cancer Advocacy Network, Cancer Support Community, Cornell Weill Prevention Clinic – Us Against Alzheimer’s, Emerson Clinical Research Institute, FDA Office of Minority Health, Fuerza Contra Alzheimer’s, GHUCCTS, Leukemia & Lymphoma Society, Men’s Health Network, MMG, WomenHeart, Optimal Research, The Person Center, Walgreens, and Whitman Walker – ACTG Research Trials.

You can view photos from the event and learn more here.

Doctor holding heart with bandage

12 Percent of People Will Be Diagnosed With This Life-Threatening Heart Disease

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Jen Hyde, a 30-year-old poet and artist living in Brooklyn, has a congenital heart defect. By the age of 25, Hyde had two open-heart surgeries, including a heart valve replacement.

“I know that heart disease is the number one killer of women in America,” Hyde said. “I’m currently in great shape, but part of staying this way means building a strong relationship with my cardiologist so that the care I receive is preventative, not reactive.”

Hyde is not alone in suffering from heart health issues — in the U.S., cardiovascular disease is the No. 1 killer of both women and men, responsible for 25 percent of deaths annually. Heart valve diseases are among the reasons for concern: five million Americans are diagnosed with heart valve disease every year.

The most common heart valve disease is aortic stenosis (AS), a disease in which the opening of the aortic valve is narrowed. AS is a progressive disease and can be life-threatening. People who have developed symptoms from severe AS have about a 50 percent chance of living two years and 20 percent chance of living five years without valve replacement.

Among those 75 and older, the prevalence of AS is as high as 12 percent — a number only expected to increase along with life expectancy. Because women generally outlive men, many women are likely to develop AS.

Often, heart valve disease goes undiagnosed. Difficulty climbing stairs or being active without running out of breath is often shrugged off as a normal sign of aging,but it could be a sign of AS and should be discussed with a healthcare provider. Other signs include fatigue, chest pain, shortness of breath, feeling faint, heart palpitations, and heart murmurs.

Risk factors for AS and other heart valve conditions can be congenital, like in Hyde’s case. Other risk factors include:

• Your age: As you age, your heart valves may become thicker and stiffer; this usually begins after age 60.
• Smoking
• Radiation therapy to the chest
• Infection, such as infective endocarditis, caused by bacteria that enters the bloodstream and settles in the heart.
• Rheumatic fever in childhood, caused by a bacterial infection that can affect the heart
• Genetics: Some types of heart valve disease tend to run in families
• Other heart problems, such as high blood pressure, high cholesterol, heart attack, heart failure and arrhythmia (irregular heartbeat)

If you think you may be at increased risk for heart valve disease, talk with your healthcare provider. Your doctor will be able to tell if there’s a problem by listening to your heart. Following up with an echocardiogram—a test that uses ultrasound waves to create an image of the heart—can usually help confirm a diagnosis.

Because heart valve disease symptoms are difficult to discern early on, it’s essential to stay on top of regular checkups and voice any concerns with your healthcare provider. Be sure to report symptoms such as chest pain, difficulty breathing, trouble exercising, fatigue, palpitations, lightheadedness and fainting. Patients and caregivers can visit www.newheartvalve.com for further resources.

A fundamental SWHR advocacy and public education priority has been to bring attention to be the burden of cardiovascular disease in women and the need to support research and innovation that provides benefit and improved quality of life to those suffering with the disease. Learn more about SWHR’s work on heart health, including the SWHR Interdisciplinary Network on Cardiovascular Disease atwww.swhr.org.

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