Understanding women's biology could reshape the future of heart disease research
Women have long been underrepresented in cardiovascular research, while biological sex differences remain poorly reflected in models of the heart's arteries. A new ERC-funded project at Aarhus University aims to help close this knowledge gap
Aarhus University
When a woman develops heart disease, it is not always the same disease - or driven by the same biological mechanisms - as in men.
Some cardiovascular diseases occur almost exclusively in women. Others present with different symptoms, develop differently or are associated with different risk factors.
This is no coincidence. Part of the explanation is that women have historically been underrepresented in cardiovascular research. But according to Monika Colombo, Associate Professor at Aarhus University, that is only half the story.
"Fortunately, we have become much better at including women in clinical research. But we are still not very good at incorporating the biology that makes women and men different into the models we use to understand cardiovascular disease. That is the fundamental knowledge we are still missing," she says.
Colombo now hopes to address that challenge through DISSEX, a research project awarded a prestigeous €1.5 million ERC Starting Grant under the European Union's Horizon Europe programme.
The project will investigate how hormones, stress and genetic factors influence women's coronary arteries and develop new models to explain why certain cardiovascular diseases affect women differently from men.
Why does an artery suddenly become vulnerable?
Researchers already understand a great deal about how blood flows through the coronary arteries and the mechanical forces acting on the vessel wall.
What they understand far less well is how the body's own biological signals influence the cells that make up those blood vessels.
How do hormonal changes affect the strength of an artery throughout life? What role does physical and psychological stress play? And how do genetic factors interact with the mechanical forces that arteries experience every second of every day?
Current scientific models can only partly answer those questions.
Through DISSEX, Colombo's team will bridge biology and biomechanics. By combining laboratory experiments, advanced medical imaging and computational modelling, the researchers will investigate how biological signals gradually alter the properties of blood vessels—and how those changes may eventually make an artery vulnerable to rupture.
"Today we can measure hormones and we can study the shape of blood vessels. What we still lack is an understanding of how the body's biology changes the cells within the vessel wall over time. That is the missing connection we are trying to uncover," says Colombo.
A disease that exposes a wider knowledge gap
The project focuses on Spontaneous Coronary Artery Dissection (SCAD), a condition in which a spontaneous tear develops within the wall of a coronary artery.
SCAD predominantly affects women, many of whom have none of the traditional risk factors associated with cardiovascular disease.
Simon Winter sees these patients in his clinical work. He is a consultant cardiologist at the Department of Cardiology at Gødstrup Regional Hospital and a clinical professor at Aarhus University, and serves as an advisor to the project.
"We see younger women coming in with what initially looks like a heart attack, but the underlying cause is not the usual build-up of plaque in the arteries. Instead, a tear develops in the artery wall, which can obstruct the flow of blood. It is a serious condition that can strike relatively early in life, and it can also take a considerable psychological toll on patients," he says.
This is precisely why SCAD challenges our current understanding of cardiovascular disease.
If clinicians are to become better at identifying who is at risk, understanding the mechanics of blood vessels alone is not enough. They also need to understand how hormones, stress and genetic factors shape the biology of the artery wall throughout a person's life.
To achieve this, the researchers will study living human coronary artery tissue and combine those findings with patient data and advanced computational models. Their goal is to uncover the biological mechanisms that gradually make an artery more susceptible to dissection.
"This is an area where we still lack fundamental knowledge. We need to understand why the condition occurs. Are some artery walls particularly vulnerable? Do hormones play a role? Or is it the result of several factors interacting? If we can identify markers and gain a better understanding of how the disease develops, we may also become better at knowing what to look out for in our patients," says Simon Winter.
From fundamental biology to more precise cardiovascular medicine
In the longer term, the researchers aim to develop personalised rupture-risk maps of the coronary arteries.
By integrating knowledge about hormones, genetics and biomechanics, they hope to identify patients at increased risk earlier and provide clinicians with better tools for diagnosis, monitoring and treatment planning.
For Colombo, however, the project's significance extends well beyond a single disease.
She hopes DISSEX will help reshape how researchers investigate women's cardiovascular health more broadly.
"If we want precision medicine, we also need models that reflect the biological diversity of patients. Women's cardiovascular physiology should not simply be regarded as a variation of a male standard. It deserves to be understood on its own biological terms," she says.
Aarhus University is home to several major initiatives focusing on women’s health. Here are five examples:
- The research project Women’s Health and Well-being is conducting Denmark’s largest-ever study of women’s health and well-being, including a survey of 300,000 women.
- PREG-AID investigates how medicines used to treat autoimmune diseases affect both mother and child during pregnancy.
- The FEMaLe project uses artificial intelligence and health data to improve the detection and treatment of endometriosis. The project has helped raise awareness of the disease in both Denmark and the EU.
- The BIOSFER project investigates the reasons behind declining fertility and explores how biological, social and psychological factors contribute.
- The Women’s Health Network brings together researchers and other stakeholders to strengthen research into women’s health.
How new moms cope with stressful news may matter more than the news itself, study finds
By Tracy DeStazio
image:
Kristine Joy Chua, a biological anthropologist in the University of Notre Dame’s Department of Anthropology.
view moreCredit: University of Notre Dame
The everchanging social, political, and economic landscape in many countries has become more tenuous and intense in recent years. Respondents in a 2026 report from the World Economic Forum indicated a prevailing mood of uncertainty, with 50 percent of them anticipating a turbulent or stormy outlook on life over the next two years. This negative perception swells to 57 percent of respondents when looking ahead to the next 10 years.
Social structures, government policies, and cultural norms shape how people think, live, and interact. If those factors are in constant flux, the repercussions can have adverse effects. More worrisome, however, is how external stressors affect pregnant women, who are already experiencing significant physiological changes in preparation for the birth of a baby and, subsequently, adjusting to life with a newborn.
If there are additional factors in a mother’s own life—such as violent, turbulent, or uncertain social or political circumstances—then her fear and anxiety will likely increase, potentially putting her and her unborn child’s health at risk. The impacts of these sociopolitical stressors could lead to preterm birth, among other complications, not to mention the psychological and physiological effects.
“Yet, we know very little about how mothers cope with these stressors,” said Kristine Joy Chua, assistant professor in the Department of Anthropology at the University of Notre Dame. Chua researches reproductive biology, maternal health, and health inequities, particularly within Filipino communities and communities of color.
This gap motivated Chua and her fellow researchers to ask the question: How do expectant mothers manage these uncertainties and cope with sociopolitical stressors? The answer became the focus of their recently published study in the journal Social Science and Medicine, of which Chua was the lead author.
Interviewing 21 pregnant Filipina women across multiple regions of the Philippines in 2021, Chua and her team sought to understand how these women internalized such stressors. They found that they used creative coping strategies, some of which are grounded in Filipino cultural practices and shaped how they navigated such uncertainties. Some reframed difficult circumstances and maintained a positive outlook, while others deliberately disengaged from political stressors and focused instead on the well-being of their families.
What causes stress and where does it come from?
According to Chua and her co-authors, previous research had been limited in that it did not address how pregnant individuals perceive and embody outside stressors and the implications for health. Nor did it address the various coping strategies they found useful in dealing with stress in order to protect their bodies and pregnancies.
The research team specifically chose to study pregnant women in the Philippines, a country marked by intense state violence, high poverty rates, political corruption, and a highly publicized war on drugs, as well as some of the world’s strictest COVID pandemic lockdown restrictions during the research period.
Their interviews with the pregnant women revealed how interconnected social, political, and economic stressors can be—with 67 percent of study participants citing financial stress, 38 percent indicating access to quality medical care, and 52 percent saying cultural pressures affected their emotional, physical, and mental well-being.
One of the societal challenges compounding this predicament for citizens of the Philippines is their outsized reliance on social media for gathering news and information—an open portal that has the potential to continuously feed them negative or politicized discourse. According to Chua and her co-authors, 62 percent of their study participants cited Facebook or other social media sites as their primary source of information, adding that the “news they ingested had a profound impact on their perceived stress levels.”
Artwork by Elissa Chudzicki/University of Notre Dame
What are some ways new moms cope?
The interviewees revealed that not all of the negative news they consumed necessarily affected them adversely. Many described relying on creative coping strategies pulled from within their Filipino identity and upbringing.
For example, noted the researchers, many expectant mothers found ways to reframe those stressors. One way to accomplish that is through the concept of “community viewing”—comparing oneself to others to determine who might be “doing better.” The realization that others within their circle might actually be relatively worse off (experiencing death, food scarcity, and extreme poverty, for example) allowed them to manage the difficulties of their own situations.
Second, maintaining a positive outlook on life and being able to “laugh things off” gave them a new perspective and renewed state of mind that enabled them to ‘build resiliency against adversity.”
Another reframing technique many expectant moms found useful was looking toward their relationships with family members and appreciating the positive aspects of their lives. Said one study participant: “We cope by remembering the blessings we have [now] and that are yet to come.”
Chua said that participants also found ways to exercise their own agency, which could manifest in one of three cultural practices. One is disengaging and remaining indifferent or resistant to the news of the day—letting the negative news “go in one ear and out the other,” as one participant described.
A second method is to invoke the mentality of bahala na—a phrase that translates to “whatever happens, happens” and is driven by a belief that God will provide. In other words, they believe that regardless of how difficult things are or how far out of their control the situation may become, these new moms and their families will somehow prevail.
Finally, respondents found outright avoidance to be a surefire way to leave some of those stressors behind and move forward with daily living. Deliberately staying silent—as opposed to engaging in political debates or trying to change others’ political opinions—allowed them to protect themselves against unpleasant, negative, and stressful experiences during pregnancy, the co-authors wrote. Rather, they focused “on concerns within their immediate control,” such as the current safety and health of their children and the general well-being of their families.
Chua emphasized that “the intent of the work is not to romanticize what might be viewed as a passive outlook or response, but to investigate the strategies these women have at their disposal to cope and deal with challenging circumstances. Doing so is harmful to the participants and to the field of study.”
What can these findings mean for other mothers?
While these specific coping strategies were utilized by the pregnant Filipina women included in Chua’s study, their insights may extend to any expectant mother living with social, political, and financial stressors.
“Maternal and fetal health is influenced not only by medical care but also by the broader social and political environment,” Chua said. “And politics definitely plays a significant role in shaping perinatal health.”
Chua said the research highlighted how further work is needed to fully understand this interaction, as well as how these coping strategies affect stress biology during pregnancy and its impact on newborn health. “Future study also needs to take into account how helpful or harmful these coping strategies may be,” she added.
“Our study is one of the first to examine how Filipina women embody politics during pregnancy,” the co-authors wrote. “We expect these findings to contribute to the advancement of women’s health on a local and global level by demonstrating the complexities associated with stress embodiment, management, and its impact on fetal development.”
Contact: Tracy DeStazio, associate director of media relations, 574-631-9958 or tdestazi@nd.edu
Journal
Social Science & Medicine
Method of Research
Survey
Subject of Research
People
Article Title
Embodiment of sociopolitical stress during pregnancy and coping strategies among perinatal Filipina women
