NIH awards $7.5M to Barbra Streisand Women's Heart Center to probe how microvascular damage shapes women’s aging
Exploring heart disease, cognitive decline and frailty as women age
The Smidt Heart Institute at Cedars-Sinai has secured a $7.5 million federal grant to investigate how damage to the body’s smallest blood vessels contributes to heart disease, cognitive decline and frailty as women age - an effort that aims to connect cardiovascular science with whole-person aging.
The five-year award from the National Institutes of Health and the National Institute on Aging will fund a study entitled Microvascular Aging Effects - Women’s Evaluation of Systemic Aging Tenacity in Heart, Brain and Frailty. known as MAE-WEST HBF. The research builds on decades of work in women’s cardiovascular health.
At the center of the project is C. Noel Bairey Merz, director of the Barbra Streisand Women’s Heart Center and principal investigator of MAE-WEST HBF. For more than 20 years, Bairey Merz has studied coronary microvascular disease - a condition that disproportionately affects women and stems from dysfunction in the heart’s smallest vessels.
“Armed with this funding, we are eager to continue uncovering biological mechanisms behind sex-based differences in aging and heart health,” Bairey Merz said.
“A better understanding of the causes of common age-related conditions in women could lead to more effective prevention and treatment strategies.”
Women live longer but are sicker
Women in the United States generally outlive men. But longevity does not necessarily equate to healthy years. Women experience higher rates of chronic disease and often spend more years living with disability, frailty or cognitive impairment.
Researchers increasingly suspect that microvascular dysfunction - damage or inflammation affecting tiny blood vessels throughout the body - may be a common biological thread linking heart disease, brain changes and musculoskeletal decline.
Earlier studies from Cedars-Sinai’s women’s heart center have found that small vessel disease, chronic inflammation and iron buildup in women are associated with impaired function in the heart, brain and kidneys, along with declining physical strength. The new MAE-WEST HBF study is designed to move beyond association and probe underlying mechanisms.
This grant comes amid broader momentum in women’s cardiovascular research - including the recent launch of a $55million global program by Wellcome aimed at transforming diagnosis and treatment of coronary microvascular disease, which women may experience despite ‘normal’ heart tests.
Connecting heart, brain and frailty
The multidisciplinary study will examine how coronary microvascular dysfunction may influence cognitive function and frailty over time. By investigating sex-based differences in multiple age-related diseases, the team aims to clarify whether early vascular changes could serve as warning signs - or even modifiable drivers -of broader systemic decline.
The project brings together cardiology, neurology and aging research expertise. Pascal Sati, director of the Neuroimaging Program in the Department of Neurology at Cedars-Sinai, will contribute advanced brain imaging capabilities. Collaborators at University of California, Los Angeles will oversee biostatistical analysis, while researchers at University of Texas at Arlington will lead the frailty research component.
“We now have effective treatments for small vessel dysfunction in the heart,” Bairey Merz said.
“If we can better understand its effects on the brain and musculoskeletal system, we may be able to find ways to prevent or slow multiple age-related diseases—including declines in cognition and mobility—in both women and men.”
A shift toward whole-person cardiovascular science
Coronary microvascular disease has historically been under-recognized, in part because its symptoms can be subtle and standard cardiac tests may not detect it. Women presenting with chest pain were often dismissed or misdiagnosed when large coronary arteries appeared clear.
Over time, research led by Bairey Merz and colleagues helped establish coronary microvascular dysfunction as a legitimate and clinically significant condition. Improved diagnostic tools and treatment strategies have since contributed to reductions in cardiovascular deaths among women.
Now, the MAE-WEST HBF study extends that work into aging science—testing whether microvascular health could serve as a unifying target across multiple conditions that erode quality of life in later years.
“After more than 25 years of progress in women’s cardiovascular research, this grant helps advance whole-person care that supports heart health, brain function and physical strength,” said Eduardo Marbán, executive director of the Smidt Heart Institute. “All three are equally essential to healthy aging.”
The grant is an example of a broader shift in women’s health research: moving beyond single-organ silos toward integrated models of aging. If microvascular dysfunction proves to be a shared pathway linking cardiovascular disease, cognitive decline and frailty, it could open the door to earlier screening strategies and preventive interventions.
It may also inform policy and funding priorities. Historically, women have been underrepresented in cardiovascular research, and sex-based biological differences have often been insufficiently explored. Large, longitudinal studies focused specifically on women’s aging trajectories remain relatively rare.
Investigators say their ultimate goal is to help shape a future in which healthy aging for women includes earlier risk detection, advanced imaging technologies and preventive care that identifies vulnerability before irreversible decline sets in.
The MAE-WEST HBF study will run for five years. Researchers hope its findings will not only clarify mechanisms of aging in women but also lay the groundwork for practical tools to extend healthspan—not just lifespan.