THE GOAL: Advance the understanding ofheart disease in women, how to prevent it, and how to optimize patient care

Minneapolis Heart Institute Foundation (MHIF) is uniquely positioned to become a national leader in the prevention, detection and treatment of heart and vascular disease in women. MHIF is an internationally recognized research institute that is integrated with a high-quality, high-volume cardiovascular care center at Abbott Northwestern Hospital (ANW) providing inpatient and outpatient services. This partnership allows us to study a large number of women with cardiovascular disease (CVD) or at risk for it.

MHIF’s goal is to secure funding to create the Women’s Cardiovascular Science Center with a leading cardiovascular-focused researcher committed to advancing women’s heart health. The appointed chair will lead the exploration into new frontiers in women’s heart health to improve the understanding of CVD in women, which undoubtedly will shape the future of how we care for all women.

The new women’s center will build upon MHIF’s commitment to conduct innovative, evidence-based research, and then translate that evidence to enhance patient care. Our proven track record of transformational research, including the Level One program, Cool It and Hearts Beat Back: The Heart of New Ulm Project, positions MHIF to make great strides in the area of women’s CVD research.

The center will be embedded within MHIF, which has 40 team members focused solely on research, ranging from population health to complex clinical research. Our access to a large number of CVD patients and their respective data make the uncommon common at MHIF, allowing us to discover new findings that will advance the understanding of heart disease, how to prevent it, and how to optimize patient care for women.

Women’s Cardiovascular Science Center

l Nearly 400,000 women’s deaths are caused by CVD each year.1

l Importantly, while death from heart disease has decreased for both genders over the past several decades, this same benefit is not true for women 55 or younger.2

l Contrary to popular belief, just as many women as men die from heart disease each year.1

While greatly impacted, women are often inadequately treatedl Heart conditions that afflict women are

often different from those that affect men,3-4 and most of these conditions have not been adequately studied.

l Women who present with heart disease symptoms are often not recognized and/or treated the same as men.5

l Compared to men, women are less likely to receive optimal therapies, interventions and rehabilitation.6-9

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Cardiovascular disease is the leading cause of death in women.

Approximately 1 woman dies from it every 80 seconds, claiming more lives than all causes of cancer combined.1

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ACTION: Address research inequities, advance careHistorically, women have been under-represented in cardiology (and other medical) research; the vast majority of research participants have been male. While it has long been assumed that treatment modalities found to be safe and effective for men are also effective for women, this is not necessarily the case. Increasing the representation of women in clinical research trials will help improve care for all women.10 While some strides have been made in recent years, knowledge gaps remain, and disparities, sometimes marked, exist in health care delivery and health outcomes between men and women.

The breadth of heart conditions affecting women has received more attention in recent years.3,5 In addition to traditional cardiovascular risk factors, women have unique risks including conditions related to pregnancy (e.g., pre-term delivery, pre-eclampsia, gestational diabetes, pregnancy-induced hypertension), autoimmune disease and breast cancer treatment.11

MHIF is strongly positioned for success with its Women’s Cardiovascular Science Center through:

l Its partnership with 70+ cardiologists, who see more than 31,000 individual patients at nearly 57,000 clinic visits each year at ANW and 36 outreach sites

l An exceptionally large and diverse patient experience complete with data contained within the electronic medical record as part of Allina Health

l A proven track record of dissemination, publishing 150 manuscripts in peer-reviewed journals and presenting novel research at regional, national and international cardiology conferences each year

l A highly talented and established team dedicated to supporting research to understand unique conditions afflicting women and to improve women’s heart health

l A commitment to hire a scientist in women’s CVD with a proven record of research success in women’s heart health, who will spend 60 percent of their time working in clinical practice and 40 percent pursuing a robust research portfolio

l MHIF’s Women’s Cardiovascular Science Center will comprehensively address research, patient and provider education, patient care and awareness in line with current best practices12

Less than 3 in 10 women are represented in

clinical research trials

Fewer than 1 in 2 women perceive

heart disease to be their greatest health threat

1 in 4 womendies from

cardiovascular disease

A recent women’s heart

health event sponsored

by MHIF featured a lively

dialogue about women’s

heart health with MHIF

physician researchers

and special guests.

• Women’s center chair successfully recruited• OB-GYN initiative partnership announced• Community engagement strategy launched

• Newresearchinitiativesforcenteridentified• $2 million leadership gift for women’s center

chair secured

2019 Funding Goal: $4.5 Million

Women’s Cardiovascular Science Center Projected Timeline 2019-2020

Q12019

Q22019

STEMI (ST-segment elevation myocardial infarction)MHIF has extensive experience with this most dangerous form of heart attack, including a database with more than 5,000 people who have been treated for a STEMI at Abbott Northwestern Hospital (ANW). Each year, more than 120 women present to ANW with this condition. We follow these individuals for up to five years to track their outcomes and progress. MHIF then uses this information to understand how heart attacks manifest differently in women vs. men to better understand appropriate treatment and prevention strategies.

Spontaneous Coronary Artery Dissection (SCAD)SCAD is an emergent condition that occurs when a tear forms in one of the heart’s blood vessels. There are typically no pre-disposing risk factors and this condition occurs primarily in women in their 30s and 40s (more than 80 percent of known SCAD cases are women13). Through a partnership with Cedars Sinai Medical Center, MHIF can identify and analyze women’s experiences to understand the best way to treat women who present with this condition. MHIF has captured data on more than 100 women with this condition.

Takotsubo Syndrome (also known as Broken Heart Syndrome or Stress Cardiomyopathy)Stress cardiomyopathy is an acute and reversible form of heart failure almost universally afflicting women and triggered by a stressful event. Increasingly common, this type of heart failure can reoccur with high rates of morbidity and mortality. The subset of patients with recurrent broken heart syndrome are an understudied population that requires meaningful examination. MHIF is uniquely positioned to study the long-term outcome of this condition, including factors predicting recurrence and any long-term health consequences. Abbott Northwestern Hospital/MHIF has one of the largest national and international stress cardiomyopathy patient population databases with more than 400 women, dating back to 2001.

Myocardial Infarction with Non-obstructive Coronary Artery Disease (MINOCA)MHIF has captured data since 2012 on more than 1,500 women who have experienced a heart attack. In nearly half of these women, their angiogram appeared normal, meaning the large arteries surrounding the heart were clear of plaque. These ‘no culprit’ cases require further analysis to understand how the disease progresses (the role of the microvasculature) and how the outcomes and treatment plans for men and women may differ.

Cardio-Oncology (Heart and Cancer Connection)Through a cardio-oncology referral program, MHIF has the ability to discover the unique heart health needs of women with a history of cancer. To date, MHIF has uncovered major cardiovascular disease in women independent of known risks associated with chemotherapy.

Prevention of Cardiovascular DiseaseMHIF has the unique opportunity to combine local data with national data to understand the causality of cardiovascular disease in women. In a study of more than 20,000 women (including data from Minneapolis Heart Institute®) who received a calcium scan — a scan of the heart that measures atherosclerosis or early heart disease — women who were found to have a significant amount of calcified plaque experienced 75 percent higher mortality than men who had a similar amount of plaque.

Cardio-PregnancyWomen face unique risk factors in pregnancy that increase their risk of cardiovasular disease both in the short and long term. Conditions such as pregnancy-induced hypertension, preeclampsia and gestational diabetes confer a two- to seven-fold risk of developing cardiovascular disease. The relationship between gestational disorders and pregnancy continues to be underdeveloped. There is also a lack of awareness about this increased risk in women with these conditions.

POISED FOR IMPACT: Key research will improve knowledge and outcomes tobenefitmillionsofwomenandtheirfamilies

Women’s Cardiovascular Science Center Projected Timeline 2019-2020

•Newresearchstudiesfocusareasidentified- Women and pregnancy- Microvascular exploration- Familial cholesterol in women- Data analytics to address women’s

heart health throughout systems of care lifespan

• Identify national partner for multi-site studies

• Fourth annual women’s engagement event

• MHIF Heartbeat Gala event to support women’s center Nov. 23, 2019

• Grand Rounds events • Half of women’s center

funding secured

Q32019

Q42019

2020 Funding Goal: $2.5 Million• Regional women’s heart conference for

primary providers and OB-GYNs

• Women’s engagement events launched (virtual education, webinars, podcasts)

• Women’s prevention speaker series planning complete

• Final $2.5 million of funding secured

Q12020

Q22020

Q42020

References1. Mozaffarian D, Benjamin EJ, Go AS, et al; American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. doi: 10.1161/ CIR.0000000000000152.

2. Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary Heart Disease Mortality Declines in the United States From 1979 Through 2011: Evidence for Stagnation in Young Adults, Especially Women. Circulation. 2015;132:997–1002. doi: 10.1161/ CIRCULATIONAHA.115.015293.

3. Shaw, L. J., Bugiardini, R., & Merz, C. N. B. (2009). Women and ischemic heart disease: evolving knowledge. Journal of the American College of Cardiology, 54(17), 1561-1575.

4. Pepine, C. J., Ferdinand, K. C., Shaw, L. J., Light-McGroary, K. A., Shah, R. U., Gulati, M., ... & ACC CVD in Women Committee. (2015). Emergence of nonobstructive coronary artery disease: a woman’s problem and need for change in definition on angiography. Journal of the American College of Cardiology, 66(17), 1918-1933.

5. Graham, G. (2016). Acute coronary syndromes in women: recent treatment trends and outcomes. Clinical Medicine Insights. Cardiology, 10, 1.

6. Abuful A, Gidron Y, Henkin Y. Physicians’ attitudes toward preventive therapy for coronary artery disease: is there a gender bias? Clin Cardiol. 2005;28:389–393.

7. Mosca L, Linfante AH, Benjamin EJ, Berra K, Hayes SN, Walsh BW, Fabunmi RP, Kwan J, Mills T, Simpson SL. National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005;111:499–510. doi: 10.1161/01. CIR.0000154568.43333.82.

8. Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender disparities in the quality of cardiovascular disease care in private managed care plans. Womens Health Issues. 2007;17:120–130. doi: 10.1016/j.whi.2007.03.002.

9. Ghisi, G. L., Polyzotis, P., Oh, P., Pakosh, M., & Grace, S. L. (2013). Physician factors affecting cardiac rehabilitation referral and patient enrollment: a systematic review. Clinical Cardiology, 36(6), 323-335.

10. Wenger, N. K., Ouyang, P., Miller, V. M., & Merz, C. N. B. (2016). Strategies and methods for clinical scientists to study sex-specific cardiovascular health and disease in women.

11. Garcia, M., Mulvagh, S. L., Merz, C. N. B., Buring, J. E., & Manson, J. E. (2016). Cardiovascular disease in women. Circulation Research, 118(8), 1273-1293.

12. Lundberg, G.P. (2018). Heart Centers for Women. Circulation, 138:1155-1165.

13. Hayes, S. N. (2014). Spontaneous coronary artery dissection (SCAD): new insights into this not-so-rare condition. Texas Heart Institute Journal, 41(3), 295-298.

920 East 28th Street, Suite 100 Minneapolis, MN 55407

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info@mhif.org

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THE NEED: Community investment in women’s cardiovascular researchGreat medical advancements require visionary leadership, sound scientific research and substantial resources. Advancing research for women’s cardiovascular care is a big goal — and one that MHIF cannot accomplish without significant community investment.

To help the Women’s Cardiovascular Science Center become a reality, MHIF requires philanthropic support of $7 million over a five-year funding period. This will enable MHIF to secure the right physician leader to address the inequities that exist in cardiovascular research and care for women, as well as provide research staff, scientific services, statistical analysis, and professional and community education.

Gifts at all levels will allow MHIF to push the boundaries in preventing, diagnosing and treating cardiovascular disease to make a difference in the lives of millions of women and their families. To help support this critically important work, please contact:

Nancy Meyer Wilson, Director of Advancement Phone: 612-863-4976 • Email: nmeyerwilson@mhif.org

www.mplsheart.org