Jennifer Michaud was born with aortic stenosis — stiffness in the valve that controls the flow of oxygen-rich blood from the heart. But it didn’t hold her back. She got a university degree, launched a career and immersed herself in Calgary’s community theatre scene.
At the age of 29, things changed. Jennifer’s heart would start racing for no reason, leaving her dizzy and breathless. Tests showed that her valve had deteriorated severely; surgery to replace it was the only option.
In many ways, Jennifer was lucky. Thanks to regular monitoring, her specialist caught the problem in time. But that’s not the case for many women with aortic stenosis. The underlying causes and symptoms are different in men and women; lack of research means women are often under-diagnosed.
“Ninety-nine point nine per cent of the studies on this condition have been done only in males, or with a large preponderance of men or male animals,” explains Dr. Marie-Annick Clavel, a cardiology researcher at Laval University.
Dr. Clavel has developed diagnostic guidelines that help clinicians recognize aortic stenosis in women. And detecting it is critical; if symptomatic severe cases go untreated, patients die.
Even when it is treated, women have worse outcomes than men. In fact, women are 25% more likely to die after aortic valve surgery.
Jennifer is glad she and her husband didn’t know that as they faced the choice between a mechanical or a biological valve replacement. With mechanical valves, patients have to take blood thinners for the rest of their lives. Biological valves are not as durable as mechanical valves.
Jennifer opted for the biological kind, like many women, even though she would likely need more surgeries. One factor in the decision: She and her husband wanted the option of having a family one day, but blood thinners make pregnancy very risky.
A week after starring in a Gilbert and Sullivan tribute, she underwent open-heart surgery.
The goal is to reduce the progression… to stop it if we’re lucky.
Today Jennifer is back at work and back on the theatre stage. But the surgery that saved her life left her exhausted and in pain for many months. “I felt like I had been hit by a truck,” she says. She does not look forward to going through it again when her new valve needs to be replaced.
Dr. Clavel’s latest research could change stories like Jennifer’s. She is looking at a drug that targets fibrosis, the most common cause of aortic stenosis in women. Results from a mouse study funded by Heart & Stroke are very promising. Now, she’s planning a study in humans.
If it proves successful, women like Jennifer might be able to postpone surgery — or avoid it altogether. “That is really thrilling,” says Jennifer.
Dr. Clavel adds: “The goal is to reduce the progression of aortic stenosis; to stop the progression if we’re lucky; and to reverse the progression if we’re amazingly lucky.”