Women's Cardiovascular Health over the Lifespan

Dr Louise Pilote

Dr Louise Pilote is a recognized sex and gender scientist, a leader in sex and gender-based cardiovascular research and a pioneer in comparative effectiveness research. She developed new methodologies to analyze gender as a variable to understand the association between gender, sex, and cardiovascular risk factors and outcomes. She demonstrated in a sentinel paper that gender mattered when it comes to heart disease: patients with a higher “femininity” score—regardless of whether they were a man or a woman—were more likely to experience a recurrent cardiac event. Dr Pilote advanced our understanding of the impact of sex and gender on health outcomes through leading the GENESIS-PRAXY study born out of her work with GENESIS, a team of 50 investigators across Canada that she assembled and led. GENESIS has played a major role in Canada in promoting sex and gender-based cardiovascular sciences both in terms of research output and capacity generation.

Sex is defined as a biological construct where one identifies as a male or female, and gender represents a social construct that is linked to power, in the form of economic and social status, that is culturally specific and varies over time. Dr Pilote’s gender index measures a comprehensive group of gender-related factors and offers a novel means to explore the relationship between sex, gender and health outcomes. (http://www.cihr-irsc.gc.ca/e/documents/praxy_gender_questionnaire-en.pdf). This work highlights that both biology (sex) and society (gender) influence presentation, process of care and health outcome in distinct yet interrelated ways. It serves as a model to incorporate gender in health research and is featured by the Canadian Institute of Health Research (CIHR) Gender and Health Institute’s sex and gender toolkit. Her measure of gender has influenced sex and gender data collection and the formation of gender studies in Germany, Switzerland, and the USA. It resulted in knowledge translation activities and is featured at Gendered Innovations at Stanford University and through invitations to present her work at the University of Toronto, Mayo Clinic, and Harvard University. Dr Pilote was awarded the Berlin Institute of Health’s Excellence Award for Sex and Gender Aspects in Health Research, highlighting the impact of her work.

Dr Pilote leads Gender Outcomes International Group to Further Well-being Development (GOING-FWD), a data science and personalized medicine project. Recently funded by CIHR and GENDER-NET+, which is part of the European EU H2020 initiative, for a total of $1.65 million, GOING-FWD is comprised of thirty investigators from five countries (Canada, Austria, Cyprus, Sweden and Spain) who will interrogate thirty cohorts of 30 million patients with four non-communicable chronic diseases (i.e. chronic kidney disease, neurological disease, metabolic syndrome, cardiovascular disease). This consortium aims to maximize risk prediction through the integration of sex and gender analysis in research using Big Data Sciences.

Enabling this methodological advancement in the distinction between sex and gender is Dr Pilote’s expertise and long-standing experience in Big Data Sciences. She is an international authority on the use of administrative data bases (“Secondary Big Data”), large prospective clinical registries, and the use of innovative study designs and data analyses. For example, she used secondary big data to compare drugs within a class, which would not be possible through clinical trials and was one of the first to conduct a registry trial taking advantage of Canadian administrative data to test the effect of report cards on secondary prevention cardiac medications. A leader in comparative effectiveness studies, she identified sex differences in the safety and efficacy of cardiac drugs and devices and uncovered clinical equipoise in anticoagulation for atrial fibrillation in dialysis patients. Clinical trials are currently ongoing because of this latter discovery which received the best paper of the year award in Circulation, the highest impact cardiology journal.

Dr Pilote also used her expertise in Big Data Sciences to co-lead and co-edit the Canadian Cardiovascular Outcomes Research Team (CCORT) atlas. This atlas, mapping regional differences in health outcomes and access to cardiovascular care in Canada, led to many quality improvement initiatives. Another major contribution in CCORT was her translation of health research to policy on the safety and effectiveness of different therapeutics at the population level. For example, she demonstrated that lifting the Canadian drug policy restricting the use of a drug preventing clotting post-percutaneous coronary intervention led to reduction in mortality. Published in the New England Journal of Medicine, this study had a major impact on drug policy.

In her leading role in the Canadian Vascular Network (CVN), Dr Pilote applied a sex and gender lens to bridge basic to epidemiological sciences. For example, she uncovered an association between hypertensive disorders of pregnancy) and cognitive decline (decades later in life); she then led a multidisciplinary team to measure novel biomarkers (micro RNAs) to explain this association. Similarly bringing together a multidisciplinary team, she currently leads a study to evaluated novel cardiac imaging (oxygen sensitive magnetic resonance imaging) to diagnose coronary microvascular dysfunction, a pathogenesis of coronary disease most prevalent in women. She also innovated as the lead organizer of the first CVN summer school in Canada by tasking speakers (basic and clinical researchers) to highlight sex differences in their field and by bringing women with lived experience as speakers.

Dr Pilote has had an important role in building capacity for sex and gender sciences not only from a scientific discovery standpoint but also through advocacy and engagement with policy makers. She is an advisor to the Heart and Stroke foundation of Canada (HSFC) on research policy regarding sex and gender and has been instrumental for the release of federal funds to HSFC, aimed at supporting research in women heart health. She serves as an expert on the Women’s Health and Brain Health Steering Committee for HSFC. She is a founding member of the Canadian Society of Gender Science and leads one of the first 4 research teams to form collaboration between CIHR and Health Canada’s Sex and Gender-based Analysis policies and projects. As the inaugural Vice-Chair, Health Canada’s Scientific Advisory Committee on Health Products for Women (SAC-HPW), Dr Pilote is poised to bridge research to policy through a sex and gender-based approach to drugs and devices approval process.

As the McGill general internal medicine division director for a decade, Dr Pilote provided opportunities for new investigators, mentored junior faculty members, recruited 19 academic clinicians to join the Division (6 recruits have obtained the FRQS remuneration recherche bursary). She provided outstanding leadership and mentorship to all levels of trainees many now holding academic positions across Canada. All the while managing her responsibilities as division director and active clinician, supervising scores of research trainees and inspiring and managing her research team.

Visit her Research Institute webpage.

Publications: View on PubMed

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