To: Congressman William Timmons

From: Caroline Kissam, RN

Date: March 5, 2021
Subject: H.Res.88 - Recognizing women's cardiovascular health as a critical health care
priority that affects every State and contributes to increased health care costs, and promoting the
necessity of increased awareness of and education on the symptoms for heart disease among
women, gender-specific cardiovascular disease research, and policy action to alleviate the risks
of heart disease among women.

Heart disease is the number one cause of death in the world. Research shows that women
have a higher risk of death from myocardial infarction than men, yet awareness of this fact is
declining. Because of this I support the H.Res.88 bill that was introduced into the house in
February 2021. I encourage you to support this bill as well in order improve the health of
women in the United States.

• The American Heart Association surveyed women in 2019 and 64.8% of those surveyed
incorrectly reported breast cancer as the leading cause death in women and only 44% were
knowledgeable about cardiovascular disease and it’s symptoms. This showed a 20% decrease
in awareness from the same survey that was conducted in 2009. (Coke & Hayman, 2021) This
survey also revealed the knowledge deficit was most common in women in the 25-34 year age
group. Surprisingly, even those women with comorbid conditions such as diabetes and
hypertension did not show greater awareness even though both of these conditions are major
risk factors for heart disease.(Coke & Hayman, 2021)
• Advancing age is the biggest risk factor for heart disease, but we are seeing an increase
in death rates in younger women age 45-65.(Okunrintemi et al., 2020)

I recommend that we encourage more women to participate in cardiovascular research

trials by requiring pharmaceutical industry sponsors as well as academic research institutions and
government agencies to pursue greater representation from women in their trials. A review of
clinical trials from 2010 to 2017 revealed that of the 740 completed cardiovascular trials on ly
38.2% of participants were women.(Jin et al., 2020) Women are physiologically different from
men, so it is important to have equal representation of both genders in clinical trials to improve
our knowledge of treatment for women.
We must improve women’s awareness of these statistics and work to encourage
prevention and early diagnosis and treatment of comorbid conditions that are associated with
heart disease. One way to do this would be to require screening for heart disease risk factors and
symptom at all health care facility interactions beginning at age 20. Many younger women don’t
get regular checkups except for trips to their gynecologist, so it is important to require screening
at all interactions with health care providers in much they same way they require depression
screenings by all physicians today.
We cannot be complacent in fighting the number one killer of women in the world. The
fact that most women are not aware that this is their biggest disease threat means that we are not
being proactive enough. It is time to take action and passing this bill will be a great beginning.
 References
Coke, L. A., & Hayman, L. L. (2021). Women's awareness of heart disease and risk two steps
forward and one step back. Journal of Cardiovascular Nursing, 36(1), 6–7. Retrieved
March 5, 2021, from
Ezekowitz, J. A., Savu, A., Welsh, R. C., McAlister, F. A., Goodman, S. G., & Kaul, P. (2020). Is
there a sex gap in surviving an acute coronary syndrome or subsequent development of
heart failure? Circulation, 142(23), 2231–2239. Retrieved March 5, 2021, from https://
doi.org/10.1161/circulationaha.120.048015
Jin, X., Chandramouli, C., Allocco, B., Gong, E., Lam, C. S., & Yan, L. L. (2020). Women’s
participation in cardiovascular clinical trials from 2010 to 2017. Circulation, 141(7),
540–548. Retrieved March 5, 2021, from https://doi.org/10.1161/circulationaha.
119.043594
Okunrintemi, V., Tibuakuu, M., Virani, S. S., Sperling, L. S., Volgman, A., Gulati, M., Cho, L.,
Leucker, T. M., Blumenthal, R. S., & Michos, E. D. (2020). Sex differences in the age of
diagnosis for cardiovascular disease and its risk factors among us adults: Trends from
2008 to 2017, the medical expenditure panel survey. Journal of the American Heart
Association, 9(24). https://doi.org/10.1161/jaha.120.018764