Where Do We Go From Here: Reflections on a Century in Women’s Cardiovascular Health Research, 1924–2024

A century ago in 1924, George Gershwin's Rhapsody in Blue debuted.Widely considered one of his most indelible creations, mixing classical music and jazz for the first time, the composition came to define a new era in American music.However, Gershwin's arrangement reflected a White perspective of jazz.It wasn't until Duke Ellington rearranged the composition in 1925 and 1932, adding additional brass instruments to achieve more complex harmonies, that the piece transcended the racialized barrier between what some have called "inauthentic" symphonic jazz and "authentic" jazz achieving its truest incarnation.In tandem with the dawn of the Jazz Age, a new epoch in medicine was being ushered in as the leading causes of morbidity and mortality pivoted from infectious to non-communicable diseases -including predominantly cardiovascular disease (CVD), which remains the #1 cause of death in women as well as men today. 1 In 1912, James Herrick's landmark paper described sudden coronary artery obstruction as a disease process occurring "nearly all in men past the middle period of life." 2 This paper was at the forefront of the rise in the admixture of epidemiology and clinical CVD research that led to unprecedented advances in our understanding of cardiovascular risk factors and improvements in the health span.Unfortunately, although Herrick published a follow-up study on coronary artery disease (CAD) in women in 1928, 3 cardiovascular dogma did not integrate this finding.Unlike music's rapid incorporation of Ellington's influence into Gershwin's piece, Herrick's initial publication left the lasting yet limited impression that CAD was a disorder of men with 'typical' anginal symptoms.This impression shaped the design of foundational epidemiologic cohorts and clinical research in the century to come.To this day, the misconception remains with many women not realizing that CVD is their leading cause of mortality.4 Notwithstanding advances in understanding the biological basis for sex differences in CVD, 5 prevailing views of women and their risks for CVD have mainly mirrored the most promulgated developments in cardiovascular epidemiology and outcomes research.As public health efforts to eradicate communicable diseases came to fruition by the mid-20th century, the success of tactics utilized in that field motivated and shed light on the need to understand CVD epidemiology as a first step in reducing the rising burden of CVD-related morbidity and mortality.