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WHAT: A new review in JAMA highlights key findings and clinical messages from the Women’s Health Initiative (WHI), the largest women’s health study in the United States. The WHI is supported by the National Institutes of Health’s National Heart, Lung, and Blood Institute (NHLBI), and was created to study factors that may reduce risks for cardiovascular disease, cancer, hip fractures, and other conditions in postmenopausal women. More than 68,000 women enrolled in clinical trials between 1993 and 1998 and were followed for up to 20 years.
After reviewing these long-term data, the researchers explain the primary findings:
Hormone therapy and menopause. The WHI study found that estrogen or a combination of estrogen and progestin, two types of hormone replacement therapies, had varying outcomes with chronic conditions, and the evidence does not support the use of these therapies to reduce risks for chronic diseases, such as heart disease, stroke, cancer, and dementia. The study was not designed to assess the effects of FDA-approved hormone therapies for treating menopausal symptoms, the benefits of which had been established before the WHI study began.
The authors reinforce the importance of women making shared decisions with physicians about the benefits or risks of taking hormone therapy during menopause. For example, women younger than age 60 with low-to-average risk for cardiovascular disease and breast cancer who want to take hormone therapy may experience greater health benefits than risks during early menopause to treat moderate-to-severe symptoms, such as bothersome hot flashes or night sweats.
Calcium and vitamin D supplements and bone fractures. A combined calcium and vitamin D supplement was not associated with reduced risks for hip fractures among postmenopausal women at average risk for osteoporosis, according to the study. However, the authors note that supplements can help fill nutrient gaps among women who do not meet the daily recommended intake for these nutrients . Therefore, women with questions about adequate intake and levels should consult with their healthcare provider.
Low-fat diets and cancer. A low-fat dietary pattern with at least five daily servings of fruits and vegetables and increased grains did not reduce the risk of breast or colorectal cancer. However, upon subsequent analyses during the follow-up period, researchers found that this type of eating pattern was associated with a reduced risk of death from breast cancer.
Findings from the clinical trials and study observations can vary based on multiple factors, such as age and underlying cardiovascular disease risks, so women ages 50 and older should work with their clinicians to make individualized and shared medical decisions, the researchers noted.
STUDY: Manson, JE, Crandall CJ, Rossouw JE, et al. The Women’s Health Initiative randomized trials and clinical practice: A review. JAMA ; 2024. Doi: 10.1001/jama.2024.6542.
WHO: Candice A. Price, Ph.D., program director of the epidemiology branch, located within the Division of Cardiovascular Sciences at NHLBI, is available to discuss this review.
About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives. For more information, visit www.nhlbi.nih.gov .
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .
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Putting science to work for the health of women
Advancing women’s health research: from policy to action , by dr. janine a. clayton.
On March 18, 2024, President Joe Biden signed a new Executive Order (EO) that builds upon the White House Initiative on Women’s Health Research . The EO outlined strategies to improve women’s health research by integrating women’s health across the federal research portfolio, prioritizing funding, galvanizing new research on women’s midlife health, and assessing areas needing further support. ORWH Deputy Director Vivian Ota Wang, Ph.D., and I were honored to attend the historic signing, alongside NIH Director Monica Bertagnolli, M.D., and Deputy Director for Program Coordination, Planning, and Strategic Initiatives Tara A. Schwetz, Ph.D., and other NIH leaders. A key aspect of this initiative was the announcement of a new NIH-wide effort to invest $200 million in Fiscal Year 2025 specifically for interdisciplinary women’s health research. This substantial investment is aligned with the administration’s commitment to advancing our understanding of women’s health issues and developing targeted interventions and treatments.
As part of the White House Initiative on Women’s Health Research, First Lady Dr. Jill Biden and I visited Research Triangle Park, home to North Carolina State University, Duke University, and the University of North Carolina at Chapel Hill, to promote the EO, specifically focusing on challenges women face in midlife like menopause and heart disease. Our collaborative efforts with renowned institutions and health care professionals emphasized the need to address disparities in health care, advocating for innovative research and health care solutions that prioritize women’s health.
Moreover, in alignment with the White House Initiative on Women’s Health Research, ORWH issued a NIH-wide Notice of Special Interest to highlight interest in receiving research applications focused on diseases and health conditions that predominantly affect women (e.g., autoimmune diseases, depressive disorders, Alzheimer’s disease and Alzheimer’s disease-related dementias, gender-based violence), present and progress differently in women (e.g., cardiovascular disease, HIV, reproductive aging and its implications), or are female specific (e.g., uterine fibroids, endometriosis, menopause). I strongly encourage applications incorporate an intersectional and/or multidimensional approach to gender-related social and structural variables, including race, ethnicity, socioeconomic status, and state and federal policies.
Congratulations to Elizabeth Barr, Ph.D. on being named Associate Director for Interdisciplinary Research at ORWH. Dr. Barr joined ORWH in 2019, where she has coordinated efforts to advance intersectional health research on gender as a social and structural variable, managed the ORWH interprofessional education program, and led efforts to advance HIV research for women. Dr. Barr’s background is in gender and women’s studies, community-led HIV research, and reproductive justice. Dr. Barr completed her Ph.D. in communications, with training in science and technology studies, at the University of Wisconsin–Madison and her M.S. in women’s and gender studies at Towson University. Prior to joining ORWH, Dr. Barr led interdisciplinary, cross-sector projects to increase women’s engagement in clinical research and served on the faculties of Towson University and the University of Maryland, Baltimore County. Dr. Barr is widely respected in the field of interdisciplinary research as demonstrated by her accomplishments above, and we look forward to her continued contributions to ORWH!
The 60th Meeting of the NIH Advisory Committee on Research on Women's Health (ACRWH), held on April 12, 2024, provided a forum for ACRWH members to give guidance and make recommendations on priority issues affecting women's health and sex differences research. Carolyn Mazure, Ph.D., White House Initiative on Women’s Health Research chair, provided an insightful update on the White House Women’s Health Research Initiative. Dawn Corbett, M.P.H., NIH inclusion policy officer, Office of Extramural Research, presented a comprehensive inclusion update on NIH clinical research. The event hosted a robust panel titled Middle-Life Health of Women and Menopause, of expert researchers that discussed how menopause can affect the health of women. The Office of Disease Prevention will host a Pathways to Prevention (P2P) workshop in 2025 to identify research gaps in the menopausal tradition and to promote well-being through midlife and beyond. Visit the ACRWH event page for the videocast recording.
In March 2024, the NIH Office of AIDS Research (OAR) and ORWH hosted a two-day virtual workshop to review the state of the science on HIV and women and inform the future research agenda. The workshop, which is part of the OAR-ORWH joint HIV and Women Signature Program , featured a diverse array of HIV-related topics of relevance to women, girls, and gender-diverse people, including prevention, treatment, cure, and social and structural determinants of health. Aligned with the signature program’s focus on intersectional, data-driven, and equity-informed approaches to HIV and women, the workshop included community members on the organizing committee and community speakers on every panel. We were also happy to feature work from established and emerging investigators, highlighting opportunities for ongoing collaborations and connections. Over 700 people watched the workshop live, and it is archived via videocast for viewing on-demand.
April marks National Minority Health Month (NMHM), a time to raise awareness about the importance of improving the health of racial and ethnic minority communities and reducing health disparities. The National Institute on Minority Health and Health Disparities celebrated this month with a series of events, including a Minority Health Walk, Run, Roll 5K and a Fireside Chat featuring the Honorable Louis W. Sullivan, M.D. Additionally, the Health and Human Services Office of Minority Health (OMH) has emphasized this year’s theme, “Be the Source for Better Health: Improving Health Outcomes Through Our Cultures, Communities, and Connections,” focusing on understanding how the unique environments, cultures, histories, and circumstances (known as social determinants of health) of racial and ethnic minority and American Indian and Alaska Native populations impact their overall health. I encourage you to learn more about health equity by using the resources made available online by OMH.
As we commemorate NMHM, I look forward to the upcoming release of the Health of Women of U3 Populations Data Book. This resource holds immense promise in offering valuable insights into the complex interplay of cultural, racial, socioeconomic, and geographical factors that can influence the health status of women. By highlighting the challenges these communities face, this data book emphasizes the urgent need for equitable health care practices to promote health equity for all.
This year, we observed Black Maternal Health Week from April 11 to 17. This week serves as a crucial platform to spotlight and address the disparities in health outcomes experienced by Black mothers. Research and data have consistently shown stark racial and ethnic disparities in maternal mortality rates, with Non-Hispanic Native Hawaiian and Pacific Islander, Black or African American, American Indian, and Alaska Native women facing mortality rates two to four times higher than Non-Hispanic White women in pregnancy-related causes. Recognizing the urgent need for action, the Health Resources and Services Administration Maternal and Child Health Bureau has spearheaded a comprehensive campaign during Black Maternal Health Week aimed at raising awareness, fostering meaningful action, and advocating for positive change in Black maternal health. In response to the disparate maternal mortality rates, the IMPROVE initiative was developed to support research on how to reduce preventable maternal mortality, decrease severe maternal morbidity, and promote health equity. Central to this effort is a toolkit featuring a range of resources strategically designed to empower individuals and organizations, providing them with the tools necessary to amplify their initiatives, forge collaborations, and celebrate achievements in the ongoing quest for equitable maternal health care for Black mothers. It is imperative these efforts continue beyond this designated week, fostering sustained awareness, advocacy, and policy changes to ensure lasting improvements in Black maternal health outcomes.
In line with ORWH’s mission to advance women in science careers, we launched a prize competition aimed at enhancing gender diversity among faculty members in higher education. This initiative underscores our commitment to breaking down barriers and fostering transformative change. The resulting NIH Prize for Enhancing Faculty Gender Diversity in Biomedical and Behavioral Science has not only encouraged innovative strategies but has also led to the development of a toolkit. This toolkit highlights best practices and links them with evidence of their impact, fostering a culture of accountability and innovation. For more information on how the toolkit was developed, click here .
Looking ahead, ORWH is excited to celebrate National Women’s Health Week by hosting the 8th Annual Vivian W. Pinn Symposium and the first ever NIH Women’s Health Roundtable event. The Vivian W. Pinn Symposium honors the first full-time director of the office, Vivian W. Pinn, M.D., and serves as a critical forum for experts across sectors to communicate and collaborate for the advancement of women’s health. The roundtable “ Future Directions in Menopause Research: Optimizing Midlife Health of Women ,” is scheduled for May 16, 2024, from 11 a.m. to 1 p.m. EDT. This event serves as the launch for the NIH Women’s Health Roundtable Series as part of the White House Women’s Health Research Initiative. The series will engage the extramural research community to bring greater awareness to female-specific health conditions, as well as diseases and conditions that present differently in women. I encourage all researchers, health care professionals, policymakers, and advocates to join us at this impactful roundtable as we collaborate to foster transformative discoveries and interventions in women's health. Your participation and insights are invaluable in driving positive change and advancing our collective mission to shape the future of women’s health research and improve outcomes for women.
The recent initiatives and collaborative efforts serve as a catalyst for continuous dialogue, innovation, and enhancing research. As we navigate the intricate landscape of health care disparities and societal complexities, ORWH’s commitment remains unwavering—to expand and accelerate women’s health research initiatives that generate new data and discoveries which will promote health equity. Together, we strive to create a future where health outcomes are improved for all populations of women, paving the way for more equitable, inclusive health care for everyone.
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A new review in JAMA highlights key findings and clinical messages from the Women's Health Initiative (WHI), the largest women's health study in the United States. The WHI is supported by the National Institutes of Health's National Heart, Lung, and Blood Institute (NHLBI), and was created to study factors that may reduce risks for cardiovascular disease, cancer, hip fractures, and other ...
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