Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice

doi:10.1016/j.mayocp.2015.11.001

Mayo Clinic Proceedings

Volume 91, Issue 2, February 2016, Pages 226-240

https://doi.org/10.1016/j.mayocp.2015.11.001 Get rights and content

Abstract

Over the past decade, an emerging clinical research focus on cardiovascular (CV) disease (CVD) risk in women has highlighted sex-specific factors that are uniquely important in the prevention and early detection of coronary atherosclerosis in women. Concurrently, a 30% decrease in the number of female deaths from CVD has been observed. Despite this, CVD continues to be the leading cause of death in women, outnumbering deaths from all other causes combined. Clinical practice approaches that focus on the unique aspects of CV care for women are needed to provide necessary resources for the prevention, diagnosis, and treatment of CVD in women. In addition to increasing opportunities for women to participate in CV research, Women's Heart Clinics offer unique settings in which to deliver comprehensive CV care and education, ensuring appropriate diagnostic testing, while monitoring effectiveness of treatment. This article reviews the emerging need and role of focused CV care to address sex-specific aspects of diagnosis and treatment of CVD in women.

Section snippets

Aspects of CV Physiology Unique to Women

The 2010 publication of the Institute of Medicine “Women's Health Research: Progress, Pitfalls, and Promise”¹¹ highlighted the fact that women's health involves both sex- and gender-specific differences. A number of factors contribute to the sex-specific differences in CVD morbidity and mortality, including biological variances due to sex chromosomes and complex effects that sex steroid hormones have on the CV system. These differences result in variations in the prevalence and presentation of

CV Adaptations to Normal Pregnancy: A “Natural Stress Test” for Women

In normal pregnancy, the female body undergoes remarkable physiologic, metabolic, and hemodynamic changes needed to support fetal health. Pregnancy has been described as a natural stress test on the CV system of women.13, 14 Normally, pregnancy-related hemodynamic variations are well tolerated by the mother; however, CVD may be initially manifested during pregnancy because of increased cardiac output demands that either expose the underlying genetic phenotypes or exacerbate minor preexisting

Polycystic Ovary Syndrome: A Metabolic Disorder Specific to Women

Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive age. The prevalence of PCOS has been estimated to be 6% to 10%, depending on which diagnostic criteria are used.³³ Classic features of PCOS include anovulatory infertility, menstrual irregularities, and hirsutism. Other important manifestations include metabolic derangements such as insulin resistance, dyslipidemia, low-grade inflammation, and a higher risk of type 2 diabetes; therefore, all women with PCOS

Menopause and the Dilemma of Menopausal Hormone Therapy

Many women seen in Women's Heart Clinics are peri- or postmenopausal, experiencing menopausal symptoms and expressing concerns about the use of MHT and CV risk. The average age of menopause in American women is 51 years.³⁵ Epidemiological data have indicated the onset of coronary artery calcification (CAC) on computed tomography and are, on average, a decade later than in men, coinciding with a “10-year lag time” after menopause.36, 37 Conversely, women with hypoestrogenic states, as seen in

Ischemic Heart Disease in Women

Sex- and gender-specific CVD research has led to a new understanding of the pathophysiology of coronary disease in women, which includes, but is not limited to, our conventional understanding of atherosclerosis. Ischemic heart disease (IHD) in women includes not only atherosclerotic obstructive coronary artery disease (CAD) but also an expanded spectrum of coronary disease, including CMD, endothelial dysfunction, vasomotor abnormalities, SCAD, and stress-induced cardiomyopathy.³

Certainly, there

Peripheral Arterial Disease in Women

Atherosclerotic lower extremity PAD impairs walking performance⁷⁷ and is associated with not only a reduced quality of life78, 79 but also a markedly increased risk of CVD events and mortality.⁸⁰ Although male sex was traditionally believed to be a risk factor for PAD, recent studies81, 82 have reported compelling results on the high prevalence of PAD in women. At the extremes of ages <40 and >80 years), women represent a greater estimated population burden of PAD, affecting the lower

Heart Failure

Although heart failure can manifest with reduced or preserved ejection fraction, women are more likely than men to develop heart failure in the setting of preserved left ventricular ejection fraction. Differences in prevalence of comorbidities also exist between men and women with HFpEF. Women are generally older and have a higher likelihood of having diabetes and systemic hypertension.⁹² Estrogen receptors in the heart modulate hypertrophy and subsequently the progression of HF.⁹³ It is

Disparities in CVD Treatment in Women

Sex-specific differences in underlying physiological mechanisms affect not only manifestations of CVD but also the response to treatment. Treatment of hypertension is generally more effective in women, however, at older ages blood pressure control is more likely to be achieved in men than in women. Thus, stroke risk may not be managed as efficiently in women. Antiarrhythmic drugs have different effects, interactions, and need for dosing adjustments in women than in men.120, 121 Similarly, RCTs

Conclusion

The CV health of women is strongly affected by sex-specific factors, including hormonal and metabolic disorders, pregnancy-related adverse CV outcomes, menopausal status, and associated autoimmune diseases. Women are predisposed to certain types of CVD, including CMD, SCAD, PAD, HFpEF, POTS, and apical ballooning syndrome. Awareness and recognition that women are at a significant risk of CVD is crucial to provide appropriate care and avoid reflexive misattribution of symptoms to noncardiac

Acknowledgments

We thank Patricia J. Best, MD; Heidi Connolly, MD, Lori A. Blauwet, MD, and Susan Wilansky, MD, for their assistance.

References (135)

L.J. Shaw et al.
Women and ischemic heart disease evolving knowledge
J Am Coll Cardiol
(2009)
E.S. Ford et al.
Coronary heart disease mortality among young adults in the U.S. from 1980 through 2002: concealed leveling of mortality rates
J Am Coll Cardiol
(2007)
J.M. Roberts et al.
Pregnancy: a screening test for later life cardiovascular disease
Womens Health Issues
(2010)
R. Kessous et al.
Recurrent pregnancy loss: a risk factor for long-term maternal atherosclerotic morbidity?
Am J Obstet Gynecol
(2014)
R. Kessous et al.
An association between preterm delivery and long-term maternal cardiovascular morbidity
Am J Obstet Gynecol
(2013)
U. Elkayam
Clinical characteristics of peripartum cardiomyopathy in the United States: diagnosis, prognosis, and management
J Am Coll Cardiol
(2011)
D.M. McNamara et al.
Clinical outcomes for peripartum cardiomyopathy in North America: results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy)
J Am Coll Cardiol
(2015)
J.G. Safirstein et al.
Predictors of left ventricular recovery in a cohort of peripartum cardiomyopathy patients recruited via the internet
Int J Cardiol
(2012)
U. Elkayam
Risk of subsequent pregnancy in women with a history of peripartum cardiomyopathy
J Am Coll Cardiol
(2014)
N.M. Daan et al.
Cardiovascular and metabolic profiles amongst different polycystic ovary syndrome phenotypes: who is really at risk?
Fertil Steril
(2014)

R. Haberl et al.

Correlation of coronary calcification and angiographically documented stenoses in patients with suspected coronary artery disease: results of 1,764 patients

J Am Coll Cardiol

(2001)

S. Devries et al.

Influence of age and gender on the presence of coronary calcium detected by ultrafast computed tomography

J Am Coll Cardiol

(1995)

L.T. Shuster et al.

Premature menopause or early menopause: long-term health consequences

Maturitas

(2010)

F. Grodstein et al.

The epidemiology of coronary heart disease and estrogen replacement in postmenopausal women

Prog Cardiovasc Dis

(1995)

R.A. Khalil

Estrogen, vascular estrogen receptor and hormone therapy in postmenopausal vascular disease

Biochem Pharmacol

(2013)

C.N. Bairey Merz et al.

Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study, part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease

J Am Coll Cardiol

(2006)

H. Sun et al.

Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina

J Am Coll Cardiol

(2002)

K. Miwa et al.

Beneficial effects of smoking cessation on the short-term prognosis for variant angina—validation of the smoking status by urinary cotinine measurements

Int J Cardiol

(1994)

J. Saw et al.

Nonatherosclerotic coronary artery disease in young women

Can J Cardiol

(2014)

J. Saw et al.

Spontaneous coronary artery dissection: prevalence of predisposing conditions including fibromuscular dysplasia in a tertiary center cohort

JACC Cardiovasc Interv

(2013)

J.J. Liang et al.

A novel application of CT angiography to detect extracoronary vascular abnormalities in patients with spontaneous coronary artery dissection

J Cardiovasc Comput Tomogr

(2014)

F. Alfonso et al.

Spontaneous coronary artery dissection: long-term follow-up of a large series of patients prospectively managed with a “conservative” therapeutic strategy

JACC Cardiovasc Interv

(2012)

M.A. Van Den Bosch et al.

The RATIO study: oral contraceptives and the risk of peripheral arterial disease in young women

J Thromb Haemost

(2003)

T.L. Weissgerber et al.

Hypertension in pregnancy is a risk factor for peripheral arterial disease decades after pregnancy

Atherosclerosis

(2013)

P.P. Wisman et al.

Young women with PAD are at high risk of cardiovascular complications

Eur J Vasc Endovasc Surg

(2012)

R.C. Lo et al.

Presentation, treatment, and outcome differences between men and women undergoing revascularization or amputation for lower extremity peripheral arterial disease

J Vasc Surg

(2014)

D. Mozaffarian et al.

American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association

Circulation

(2015)

K.A. Wilmot et al.

Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women

Circulation

(2015)

A. Towfighi et al.

Sex-specific trends in midlife coronary heart disease risk and prevalence

Arch Intern Med

(2009)

E.G. Nabel

Heart disease prevention in young women: sounding an alarm

Circulation

(2015)

L. Mosca et al.

Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey

Circulation

(2013)

J.M. Kling et al.

Go Red for Women cardiovascular health-screening evaluation: the dichotomy between awareness and perception of cardiovascular risk in the community

J Womens Health (Larchmt)

(2013)

L. Mosca et al.

American Heart Association. Tracking women's awareness of heart disease: an American Heart Association national study

Circulation

(2004)

J. Pregler et al.

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results

J Womens Health (Larchmt)

(2009)

Institute of Medicine Committee

Women's Health Research: Progress, Pitfalls, and Promise

(2010)

V.M. Miller et al.

Implications for reproductive medicine: sex differences in cardiovascular disease

Sex Reprod Menopause

(2011)

L.A. Barbour et al.

Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes

Diabetes Care

(2007)

T. Männistö et al.

Elevated blood pressure in pregnancy and subsequent chronic disease risk

Circulation

(2013)

J.W. Rich-Edwards et al.

Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health?

Epidemiol Rev

(2014)

S. Kew et al.

Cardiometabolic implications of postpartum weight changes in the first year after delivery

Diabetes Care

(2014)

L. Mosca et al.

Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association

Circulation

(2011)

B.J. Wilson et al.

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study

BMJ

(2003)

N.M. Breetveld et al.

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

BJOG

(2015)

B.R. Shah et al.

Increased risk of cardiovascular disease in young women following gestational diabetes mellitus

Diabetes Care

(2008)

C. Kim et al.

Gestational diabetes and the incidence of type 2 diabetes: a systematic review

Diabetes Care

(2002)

G.D. Pearson et al.

Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review

JAMA

(2000)

K. Sliwa et al.

Heart Failure Association of the European Society of Cardiology Working Group on Peripartum Cardiomyopathy. Current state of knowledge on aetiology, diagnosis, management, and therapy of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Working Group on peripartum cardiomyopathy

Eur J Heart Fail

(2010)

National Institutes of Health, U.S. National Library of Medicine. Drugs and Lactation Database (LactMed)....

P. Tomasulo

LactMed-new NLM database on drugs and lactation

Med Ref Serv Q

(2007)

W.A. March et al.

The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria

Hum Reprod

(2010)

Cited by (38)

Sex, Gender, and Women's Heart Health: How Women's Heart Programs Address the Knowledge Gap
2024, CJC Open
This article aims to bridge existing knowledge gaps that impact clinical cardiovascular care and outcomes for women in Canada. The authors discuss various aspects of women’s heart health, emphasizing the efficacy of multidisciplinary care in promoting women’s well-being. The article also identifies the impact of national women’s heart health campaigns and the value of peer support in improving outcomes. The article addresses the particular risks that women face, such as pregnancy-related complications and hormone replacement therapy, all of which are associated with cardiovascular events, and highlights the differences in ischemic symptoms between men and women. Despite improvements in acute event outcomes, challenges persist in accessing timely ambulatory care, particularly for women. Canada has responded to these challenges by introducing Women Heart Programs, which offer tailored programs, support groups, and specialized testing. However, these programs remain few in number and are found only in urban settings. Overall, this review identifies sex and gender factors related to women’s heart health, underscoring the importance of specialized programs and multidisciplinary care in improving women’s cardiovascular health.
Cet article vise à répondre aux incertitudes actuelles qui se répercutent sur les soins cardiovasculaires et les issues cliniques chez les femmes au Canada. Les auteurs abordent différents aspects de la santé cardiaque des femmes, mettant l’accent sur l’efficacité des soins multidisciplinaires pour améliorer le bien-être des femmes. L’article présente également l’effet des campagnes nationales sur la santé cardiaque des femmes et l’importance de l’entraide entre collègues pour améliorer les résultats. L’article traite des risques particuliers touchant les femmes, comme les complications liées à la grossesse et l’hormonothérapie substitutive, qui sont toutes associées à des événements cardiovasculaires, et il souligne les différences entre les hommes et les femmes pour ce qui est des symptômes ischémiques. Bien que des améliorations aient été observées quant à l’issue des événements aigus, des difficultés persistent sur le plan de l’accès rapide à des soins ambulatoires, surtout pour les femmes. Le Canada a répondu à ces difficultés en créant des programmes pour la santé cardiaque des femmes, qui offrent des services adaptés, des groupes de soutien et des analyses spécialisées. Cependant, ils sont encore peu nombreux et accessibles seulement en milieu urbain. Dans l’ensemble, cette analyse définit les facteurs liés au sexe et au genre qui interviennent dans la santé cardiaque des femmes, soulignant l’importance de mettre en place des programmes spécialisés et des soins multidisciplinaires pour améliorer la santé cardiovasculaire des femmes.
Gender Differences in Medical Student Perceptions of a Career in Cardiology
2023, Heart Lung and Circulation
Worldwide, the cardiology profession has an under-representation of women. We assessed medical students’ perceptions of cardiology as a career choice with the aim of identifying barriers to gender diversity.
An anonymous survey was distributed to medical students studying at three Australian medical universities. Questions pertained to demographics, year and stage of medical training, desire to pursue cardiology, and perceived barriers to a cardiology career. Results were analysed according to identified gender and desire to pursue or not pursue a cardiology career. Multivariable logistic regression evaluated for independent associations. The primary outcome were barriers identified to pursuing a career in cardiology.
From 127 medical student respondents (86.6% female, mean age 25.9±4.8 years), 37.0% stated they wanted to pursue a career in cardiology (39.1% of women versus 23.5% of men, p=0.54). The top four perceived barriers to a cardiology career included: poor work–life balance (92/127, 72.4%), physician training process (63/127, 49.6%), on-call requirements (50/127, 39.4%) and lack of flexibility (49/127, 38.6%), with no gender differences. Women were more likely to report gender-related barriers (37.3% versus 5.9%, p=0.01) and less likely to identify procedural aspects as a barrier (5.5% women versus 29.4% men, p=0.001). Students in their pre-clinical years were more likely to want a career in cardiology (odds ratio 3.0, 95% confidence interval 1.2–7.7, p=0.02).
A high proportion of female and male medical students want to pursue a career in cardiology with both genders identifying major barriers of poor work–life balance, lack of flexibility, on-call requirements and the training process.
A Survey of Female-Specific Cardiovascular Protocols in Emergency Departments in Canada
2023, CJC Open
Cardiovascular diseases (CVD) remain the leading cause of death for women. However, systematic inequalities exist in how women experience clinical cardiovascular (CV) policies, programs, and initiatives.
In collaboration with the Heart and Stroke Foundation of Canada, a question regarding female-specific CV protocols in an emergency department (ED), or an inpatient or ambulatory care area of a healthcare site was sent via e-mail to 450 healthcare sites in Canada. Contacts at these sites were established through the larger initiative—the Heart Failure Resources and Services Inventory–conducted by the foundation.
Responses were received from 282 healthcare sites, with 3 sites confirming the use of a component of a female-specific CV protocol in the ED. Three sites noted using sex-specific troponin levels in the diagnosis of acute coronary syndromes; 2 of the sites are participants in the hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE MI) trial. One site reported the integration of a female-specific CV protocol component into routine use.
We have identified an absence of female-specific CVD protocols in EDs that may be associated with the identified poorer outcomes in women impacted by CVD. Female-specific CV protocols may serve to increase equity and ensure that women with CV concerns have access to the appropriate care in a timely manner, thereby helping to mitigate some of the current adverse effects experienced by women who present to Canadian EDs with CV symptoms.
Les maladies cardiovasculaires (MCV) demeurent la principale cause de décès chez les femmes. Toutefois, il existe des inégalités systématiques à l’égard des femmes dans les politiques, les programmes et les initiatives cliniques cardiovasculaires (CV).
En collaboration avec la Fondation des maladies du cœur et de l’AVC du Canada, une question relative à l’utilisation de protocoles de prise en charge des manifestations cardiovasculaires spécifiques aux femmes dans les services d’urgence ou les services de soins pour patients hospitalisés et ambulatoires a été envoyée par courriel à 450 établissements de santé au Canada. Les contacts ont été établis dans ces centres dans le cadre d’une initiative de plus grande envergure, l’inventaire des ressources et des services en matière d’insuffisance cardiaque, menée par la Fondation.
Des réponses ont été reçues de 282 établissements de santé; dont trois ont confirmé l’utilisation d’une composante spécifique aux femmes dans leurs protocoles de prise en charge des manifestations CV dans leur service des urgences. Trois centres ont déclaré utiliser un taux de troponine adapté au sexe pour le diagnostic du syndrome coronarien aigu; or, deux de ces centres participent à l’essai CODE MI (hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women), qui porte sur l’optimisation du diagnostic de l’infarctus du myocarde aigu ou des atteintes myocardiques chez les femmes. Un seul centre a signalé l’intégration d’une composante spécifique aux femmes dans son protocole CV en pratique courante.
Nous avons constaté que l’absence de protocoles spécifiques aux femmes en matière de prise en charge des manifestations CV dans les services d’urgences pourrait être associée aux moins bons résultats observés chez les femmes atteintes de MCV. Des protocoles spécifiques aux femmes en matière de prise en charge des manifestations CV pourraient contribuer à accroître l’équité et à faire en sorte que les femmes souffrant de problèmes CV aient accès aux soins appropriés en temps opportun. Une telle initiative contribuerait à atténuer certains des effets indésirables dont sont victimes les femmes qui se présentent aux urgences des établissements de soins canadiens avec des symptômes CV.
Cardiovascular Risk Screening among Women Veterans: Identifying Provider and Patient Barriers and Facilitators to Develop a Clinical Toolkit
2022, Women's Health Issues
Citation Excerpt :
In the context of the urgent priority to decrease women's CV risks, a user-friendly, cocreated toolkit holds potential for identifying and addressing pathways to improved health outcomes and risk reduction. Although CVD mortality (and specifically coronary heart disease mortality) has decreased for men and women overall during the past two decades (Arora et al., 2019; Gupta et al., 2014; Virani et al., 2020; Wilmot, O'Flaherty, Capewell, Ford, & Vaccarino, 2015), women who are young, are non-Hispanic Black or Hispanic, have diabetes, have pregnancy-related CV complications, or have uncontrolled traditional risk factors urgently need counseling and intervention to impact their CV risks and outcomes (Garcia et al., 2016). Systematic CV screening and goal setting for lifestyle change is a first step for all women.
Cardiovascular (CV) disease is the leading cause of death among women in the United States, making CV risk screening and management a women's health priority. Objectives were to elicit barriers and facilitators to CV risk identification and reduction among women veterans, and iteratively cocreate clinical tools to identify CV risk factors and promote goal-setting for lifestyle changes.
We conducted three exploratory focus groups with 21 Veterans Health Administration primary care team members and piloted patient CV screeners with brief interviews with 19 patients from two Veterans Health Administration women's clinics to inform toolkit development. We then conducted two focus groups and one interview for feedback from a total of 12 staff on the proposed toolkit components. Transcripts were summarized, and a matrix analysis was used to synthesize qualitative findings.
Provider-identified barriers included difficulties disseminating CV information in clinic, limited patient knowledge, and lack of organized resources for provider communication and available referrals. Women's complex health needs were notable challenges to CV risk reduction. Facilitators included having a single place to track patient CV risks (e.g., an electronic template note), a patient screening worksheet, and aids to complete referrals. Patient-identified barriers included difficulties balancing health, finances, and physical and mental health concerns. Facilitators included resources for accountability and gender-specific information about CV risks and complications. Providers requested easy, accessible tools in the electronic record with gender-specific CV data and resources linked. Patients requested lifestyle change supports, including trustworthy sources vetted by providers.
Iteratively eliciting end-users’ perspectives is critical to developing user-friendly, clinically relevant tools. CV risk reduction among women veterans will require multilevel tools and resources that meet providers' and women's needs.
The Canadian Women's Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman
2022, CJC Open
Women have unique sex- and gender-related risk factors for cardiovascular disease (CVD) that can present or evolve over their lifespan. Pregnancy-associated conditions, polycystic ovarian syndrome, and menopause can increase a woman’s risk of CVD. Women are at greater risk for autoimmune rheumatic disorders, which play a role in the predisposition and pathogenesis of CVD. The influence of traditional CVD risk factors (eg, smoking, hypertension, diabetes, obesity, physical inactivity, depression, anxiety, and family history) is greater in women than men. Finally, there are sex differences in the response to treatments for CVD risk and comorbid disease processes. In this Atlas chapter we review sex- and gender-unique CVD risk factors that can occur across a woman’s lifespan, with the aim to reduce knowledge gaps and guide the development of optimal strategies for awareness and treatment.
Les femmes présentent des facteurs de risque de maladies cardiovasculaires (MCV) uniques, liés au sexe et au genre, qui peuvent se manifester ou évoluer tout au long de leur vie. Les troubles médicaux associés à la grossesse, le syndrome des ovaires polykystiques et la ménopause peuvent augmenter le risque de MCV chez une femme. Les femmes sont plus exposées aux troubles rhumatologiques auto-immuns, qui jouent un rôle dans la prédisposition et dans la pathogenèse des MCV. L’influence des facteurs de risque traditionnels pour les MCV (par exemple, le tabagisme, l’hypertension, le diabète, l’obésité, la sédentarité, la dépression, l’anxiété et les antécédents familiaux) est plus importante chez les femmes que chez les hommes. Enfin, il existe des différences entre les sexes dans la réponse aux traitements du risque de MCV et des processus pathologiques comorbides. Dans ce chapitre de l’Atlas, nous passons en revue les facteurs de risque de MCV propres au sexe et au genre qui peuvent survenir tout au long de la vie d’une femme, dans le but de réduire les lacunes dans les connaissances et d’orienter l’élaboration de stratégies optimales de sensibilisation et de traitement.
Epidemiology and Prevalence
2021, Sex Differences in Cardiac Diseases: Pathophysiology, Presentation, Diagnosis and Management
Cardiovascular disease (CVD) is the leading cause of death in both men and women in the United States and most other developed countries. In 2016, CVD claimed the lives of 412,244 women in the United States. Growing knowledge of sex differences in symptoms/clinical presentation, pathophysiology of CVD, reliability of diagnostic tests, and responses to treatments, as well as an improved recognition of nontraditional risk factors specific to women, have resulted in improved clinical outcomes in women. However, despite these advances, CVD continues to be the leading cause of morbidity and mortality in both women and men in the United States. Women face disparities in diagnosis, treatment, and research related to heart disease. Persistent differences in risk factor prevalence, healthcare access, low levels of awareness by both the public and medical communities leading to underdiagnosis, delayed adoption of evidence-based guidelines in women, and major knowledge gaps are some of the factors contributing to CVD disparities. The objective of this chapter is to address the known sex differences in CVD based on epidemiologic and clinical data, characterize current sex-specific health disparities, discuss challenges, and identify strategic pathways to improve the cardiovascular health of women.

View all citing articles on Scopus

View full text

ReviewFocused Cardiovascular Care for Women: The Need and Role in Clinical Practice

Abstract

Section snippets

Aspects of CV Physiology Unique to Women

CV Adaptations to Normal Pregnancy: A “Natural Stress Test” for Women

Polycystic Ovary Syndrome: A Metabolic Disorder Specific to Women

Menopause and the Dilemma of Menopausal Hormone Therapy

Ischemic Heart Disease in Women

Peripheral Arterial Disease in Women

Heart Failure

Disparities in CVD Treatment in Women

Conclusion

Acknowledgments

J Am Coll Cardiol

J Am Coll Cardiol

Womens Health Issues

Am J Obstet Gynecol

Am J Obstet Gynecol

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol

J Am Coll Cardiol

Fertil Steril

J Am Coll Cardiol

J Am Coll Cardiol

Maturitas

Prog Cardiovasc Dis

Biochem Pharmacol

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol

Can J Cardiol

JACC Cardiovasc Interv

J Cardiovasc Comput Tomogr

JACC Cardiovasc Interv

J Thromb Haemost

Atherosclerosis

Eur J Vasc Endovasc Surg

J Vasc Surg

American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2015 update: a report from the American Heart Association

Circulation

Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women

Circulation

Sex-specific trends in midlife coronary heart disease risk and prevalence

Arch Intern Med

Heart disease prevention in young women: sounding an alarm

Circulation

Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association national survey

Circulation

Go Red for Women cardiovascular health-screening evaluation: the dichotomy between awareness and perception of cardiovascular risk in the community

J Womens Health (Larchmt)

American Heart Association. Tracking women's awareness of heart disease: an American Heart Association national study

Circulation

The heart truth professional education campaign on women and heart disease: needs assessment and evaluation results

J Womens Health (Larchmt)

Women's Health Research: Progress, Pitfalls, and Promise

Implications for reproductive medicine: sex differences in cardiovascular disease

Sex Reprod Menopause

Cellular mechanisms for insulin resistance in normal pregnancy and gestational diabetes

Diabetes Care

Elevated blood pressure in pregnancy and subsequent chronic disease risk

Circulation

Pregnancy characteristics and women's future cardiovascular health: an underused opportunity to improve women's health?

Epidemiol Rev

Cardiometabolic implications of postpartum weight changes in the first year after delivery

Diabetes Care

Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association

Circulation

Hypertensive diseases of pregnancy and risk of hypertension and stroke in later life: results from cohort study

BMJ

Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women

BJOG

Increased risk of cardiovascular disease in young women following gestational diabetes mellitus

Diabetes Care

Gestational diabetes and the incidence of type 2 diabetes: a systematic review

Diabetes Care

Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review

JAMA

Eur J Heart Fail

LactMed-new NLM database on drugs and lactation

Review
Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice