Health, happiness and hormones
Paul Dudley White lecturer urges clinicians to welcome new perspectives on cardiometabolic health.
The American Heart Association’s Paul Dudley White International Lecture featured Susan R. Davis, PhD, AO, MBBS, FRACP, FAHMS, whose career has centered on understanding sex hormones and their impact on women’s health. In her talk Sunday — “Cardiometabolic Health: Do Sex Steroids Matter?” — Davis urged clinicians to rethink assumptions about menopause and cardiovascular risk.
Davis emphasized that menopause research remains underprioritized and often oversimplified. “The question seems simple, but disentangling the available information is complex,” she said.
Although menopause is only one phase of life, its influence on cardiometabolic health is significant. Davis called for a “lifespan approach” that considers early life factors such as nutrition and exercise to better predict and prevent disease.
Hormonal history
The study of women’s health, menopause and sex hormones is ever evolving, but has long been sidetracked by misunderstanding, according to Davis. She is director of the Monash University Women’s Health Research Program and head of the Women’s Endocrine Clinic at Alfred Hospital Melbourne in Australia.
Following the abrupt halt of the Women’s Health Initiative estrogen-plus-progestin trial in 2002, the use of hormone replacement therapy declined amid concerns about increased cardiovascular risk. Davis noted that views remain polarized — ranging from avoiding hormones entirely to prescribing them to all women at menopause. Independent studies she led, however, reveal a more nuanced picture.
Among those findings:
• Both menopausal hormone therapy and simvastatin improved cholesterol levels. But the hormone therapy also significantly lowered levels of lipoprotein (a), a key cardiovascular risk marker, while simvastatin did not.
• Menopausal hormone therapy improved vascular endothelial function, while pravastatin showed minimal effect.
More recently, Davis has explored testosterone’s role in women, finding that it can have favorable effects on cardiovascular health.
In her lecture, Davis cautioned attendees to avoid making clinical decisions on incomplete evidence and urged them to reconsider health care practices rooted in anecdotal analysis or popular belief. She advocated for approaches that foster shared decision-making to improve patient care.
Reshaping sex-based care
It’s no wonder Davis was selected to lecture in honor of physician Paul Dudley White — a founding member of the American Heart Association and a pioneer of modern and preventive medicine. Davis’s work has enhanced current understanding of sex hormones in cardiovascular and musculoskeletal health, as well as in cognition, mood and sexual function. Her discoveries have influenced global health care delivery and helped shape best practice recommendations, such as the Practitioner’s Toolkit for Managing Menopause.
Looking ahead, Davis aims to expand research on sex hormones across the lifespan on a large scale, integrating factors such as exercise and metabolic health to inform prevention strategies. Menopause is a single phase, but each phase impacts the next, she said.
