Data Limitations
To improve our understanding and management of CVD among women, we must examine surveillance capabilities, research methodologies, and heart health policies and services (see also the gaps identified in the bulleted points below). With regard to the surveillance of the diagnosis and detection of CVD, we urgently need incidence estimators at the population level (such as the MONICA/ICONS project in Nova Scotia). We lack data on recent physical measures (i.e. hypertension, lipid profiles), for which self-reporting is notoriously poor. We need recent data on who is undergoing treatment for hypertension, hyperlipidemia and depression, and the effectiveness of these treatments. We are unable to capture the number of women or men undergoing stress tests, angiography, echocardiography or 24-hour blood pressure monitoring.
Information on risk factor incidence and prevalence across the lifespan is also lacking. Methodologically speaking, person-oriented data for women (and men) would enable us to follow Canadians longitudinally through the health care system and across the lifespan.
Surveillance data regarding health services evaluation are lacking. We are unable to determine the prevalence of medication prescription, compliance with treatment, or prevention of CVD and CBVD. Physician service utilization data for CVD/CBVD (as compared with those without CVD/CBVD), patient access to physician offices for prevention of CVD/CBVD (i.e. determined through physician billing data at the provincial level), and hospitalization data for patients with CVD/CBVD versus those without it are deficient. In short, the following gaps are notable:
• incidence indicators at the population level;
• recent data on physical measures, such as hypertension and lipid profile;
• information on people undergoing treatment for hypertension and hyperlipidemia, and the control rate;
• person-oriented data to follow people through the health care system;
• prevalence of prevention and detection programs, including community heart health and smoking cessation programs;
• national drug data for the treatment and prevention of CVD/CBVD;
• the changing prevalence of congestive heart failure; and
• the number of women and men undergoing stress tests, angiograms, echocardiography and holteronitoring.
Policy Considerations
With regard to healthy public policy, CVD needs to be recognized as a women's health issue, given the Canadian mortality projections, the aging population, and rampant inequities in health care access and provision. Health professionals should be trained to screen and address CVD risk factors in women, such as hypertension, elevated lipid levels, smoking, physical inactivity, depression, diabetes mellitus and low SES. We need to continue developing and evaluating educational resources for women across the lifespan regarding their risk for CVD and symptom presentation. Efforts to encourage healthy eating habits and physical activity through a multiplicity of approaches should be pursued. This may include working with local governments, workplaces, health care providers and the media to promote the importance of physical activity while recognizing the unique circumstances of women and girls (e.g. by providing a safe environment). Finally, attention must be paid to barriers to physical activity among women of diverse ethnocultural backgrounds and social classes.