Harris Co-Edits Book Focused on Vascular Disease in Women

Its purpose was to launch a discussion among vascular physicians on how vascular disease, which is disease of blood vessels, such as the arteries and veins, may be different in women than in men and what that means for diagnosis and treatment.

Those discussions proved so productive that conference organizers realized that a book about women’s vascular health was a vital next step.

The result is, “Vascular Disease in Women: An Overview of the Literature and Treatment Recommendations” (Elsevier, August 2021).

The volume is edited by Linda M. Harris, MD, professor of surgery and director of the Jacobs School’s vascular surgery integrated residency program, and Caitlin W. Hicks, MD, associate professor of surgery at Johns Hopkins University School of Medicine.

The book is based in part on the contributions of panelists at the 2019 conference, all of whom were female, and supplemented by additional contributions from other surgeons with an interest in the impact of sex on vascular disease.

The goal of both the conference, which has now been held twice (most recently conducted virtually in April), and the book is to better educate medical providers about the differences in vascular disease presentation and outcomes in women, and to highlight the issues that will help to make diagnosis and appropriate treatment more likely.

“I want clinicians to start thinking about vascular disease in women, to understand that many women do have vascular disease, but their presentation is not going to be textbook,” says Harris, a vascular surgeon with UBMD Surgery.

“I want them to know that if a woman presents with symptoms, they should consider doing some testing because their presentation just won’t be classical, as textbook symptoms tend to be based on presentation in men,” she adds.

For example, among the topics the book explores is the fact that a woman experiencing a stroke may have different symptoms than a man.

“It may not be weakness in an arm or a leg as it might be in a man, but may present differently at first, such as a sudden memory issue, and the clinician may not be expecting that,” Harris explains.

In addition, Harris says, sometimes women develop vascular disease at a later age than men typically do, so they are more frail, which also affects their symptoms.

She says clinicians need to know, too, that women may experience aneurysms (the potentially dangerous bulging of an artery wall) in different parts of their bodies than men, so that they can more immediately make these diagnoses.

“Prevention and screening in women should also be considered,” Harris says. “Women who smoke or have a family history of aneurysms should be considered for screening, as per Society for Vascular Surgery recommendations, which hasn’t typically been done as it is not covered by Medicare currently.”

The book also discusses how race and culture issues, such as unconscious bias, play a role in affecting how vascular disease in women is often misdiagnosed or missed.

“We know that there is also sex bias in research, whether that’s surgical, clinical or even basic research,” Harris says. “For example, the cell lines that are studied at a basic science level are almost always male cell lines, so potential hormonal impacts aren’t addressed. This isn’t conscious bias, it’s unconscious bias.”

“Everything is awareness,” Harris continues. “If we don’t know we have a problem, then we’re never going to fix it.”