A study from the heart
Levelling the playing field
of cardiovascular disease
By now, you might think modern science would know all there is to know about the human heart. But as Dr Eylem Levelt, a cardiologist and Associate Professor at Leeds, is proving, research continues to throw up intriguing new discoveries that could dramatically improve health outcomes for large populations.
When it comes to matters of the heart, men and women just aren’t on an equal footing.
Despite women being twice as likely to die of coronary heart disease in the UK as they are of breast cancer, it’s still commonly seen as something of a male issue. When researchers from the American Heart Association asked women about their greatest personal health risks, almost 50% knew heart disease was the leading cause of death – yet only 13% ranked it highest.
Sadly, cardiology is an area in which misunderstandings can prove fatal.
“I’ve noticed that in the majority of times when female patients would come in with a heart attack, they would die,” Dr Eylem Levelt, an Associate Professor of Cardiovascular Imaging at the University of Leeds, said. “Male patients seemed to respond better to treatment.”
It’s what the British Heart Foundation calls the heart attack gender gap; the charity’s 2019 research found that more than 8,200 women in England and Wales died over a 10-year period because of inequalities in care.
“The symptoms can be the same, but a lot of women present with different heart symptoms to those experienced by men,” Eylem explained. “They can often be dismissed, regarded as atypical, or misdiagnosed, but they do suffer from heart disease.
“And when women do have heart disease, the outcomes are fairly bleak.”
There’s surprisingly little research into women’s heart health.
Witnessing the different fortunes of the sexes is what inspires Eylem, who is also an Honorary Consultant Cardiologist at The Leeds Teaching Hospitals NHS Trust, to conduct studies aimed at improving the odds for patients.
“There’s surprisingly little research into women’s heart health,” she said. “So I’m hoping that our work will raise awareness about it and shine a light on how we can provide better care – because a lot of these deaths are preventable.”
Groundbreaking research, born in Leeds
Together with the PhD students she supervises, cardiology colleagues and other medical specialists from across the University, Dr Levelt embarked on a study that would win her a Women as One Escalator Award – more on which later.
“We wanted to look at women with gestational diabetes and women with preeclampsia in the third trimester of pregnancy, to see whether there were any changes in myocardial energetics, function or tissue characteristics,” Eylem said.
“Essentially, do complications in pregnancy have a negative effect on the heart? No-one was really looking into this, even though compromised cardiac energy production is a key contributor to most forms of heart disease.”
In the study, 83 pregnant women – 38 of whom were healthy, 30 of whom had gestational diabetes mellitus, and 15 of whom had preeclampsia – underwent cardiac imaging.
Just getting to this point was the result of a truly collaborative effort.
“My PhD student Dr Sharmaine Thirunavukarasu and Dr Faiza Ansari, who is a Research Fellow in the Department of Obstetrics and Gynaecology at Leeds, were really the face of the research,” Eylem said.
They did the recruitment, screening hundreds of potentially eligible people by reviewing their patient notes, contacting them with information and securing their participation, and later did the analysis, too.
“Actually, our first participant was also someone from the University: Dr Maria Paton, a Doctoral Research Fellow in Cardiology. She was very calm and confident in us and her scan went perfectly, which was a huge relief because we had spent months setting up the study.”
What Eylem’s team found was alarming.
“Despite having no prior diagnosis of diabetes or hypertension, the women with gestational diabetes and preeclampsia had lower energy levels in their hearts,” she explained.
“Not only that, the shape and mass of their hearts had changed, which is really important information for a cardiologist to consider. It made me even more worried about the population of pregnant women.”
Only the beginning
The study is due to be published soon in the peer-reviewed Diabetes Care Journal with 25 co-authors – including Dr Levelt, Dr Thirunavukarasu, Dr Ansari, Professor of Medicine Eleanor Scott, gynaecologist Dr Tom Everett, and professors of cardiology John Greenwood and Sven Plein.
Based on the work, Eylem decided to put herself forward for an Escalator Award from Women as One, an NGO that promotes female talent in medicine.
To her surprise, she won.
It was amazing because I was up alongside international projects that did incredible things in communities in places like Africa – a real honour.
But the recognition will not see Eylem rest on her laurels. In fact, she’s busier than ever.
“I’m working on multiple studies in valve disease and inherited heart conditions like hypertrophic cardiomyopathy,” she said.
“Plus, this isn’t the only group of PhD students that I supervise; there are some in valve disease, diabetes studies and drug trials. I’m also a mum, and I’m actually doing an MSc in Clinical Trials at the University of Oxford – today I woke up at 4am to finish a dissertation.”
Dr Levelt is keen to explore the link between pregnancy complications and heart disease further, too.
“I want to do more studies on it – bigger studies, with larger sample sizes,” she said.
“We owe it to women everywhere to do as much as we can.”
About Eylem
Dr Eylem Levelt is an Associate Professor of Cardiovascular Imaging at the University of Leeds.
Her research focuses on cardiac metabolism and advanced cardiovascular magnetic resonance imaging techniques. She is particularly interested in promoting the early detection and prevention of cardiovascular diseases in young women to address gender inequalities in their prevalence and outcomes.
Eylem is also a Wellcome Trust Clinical Career Development Fellow, an Honorary Consultant Cardiologist at The Leeds Teaching Hospitals NHS Trust, and the winner of a 2022 Women as One Escalator Award.
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