Adopting a broader approach to women’s health
Heart disease remains the leading cause of death for women being responsible for 35% of total deaths in women in 2019 (1). Heart disease includes heart rhythm problems, heart failure and coronary (heart) artery disease. There are some well-established risk factors such as a strong genetic disposition (hereditary), hypertension (high blood pressure), diabetes, obesity, high cholesterol, poor diet, inactive lifestyle, and smoking. There are also some sex specific risk factors for women which many may not know about and these include premature menopause, gestational diabetes, and poly cystic ovary syndrome. Interestingly, there are some under-recognised risk factors that relate to women such as psychosocial factors (i.e. depression), intimate partner violence (which may lead to poor lifestyle choices and increased stress), poor health literacy and low socioeconomic factors (e.g. can afford healthcare leading to poor healthcare access).
This year, 2021, the first-ever global report about cardiovascular disease in women was published in a leading scientific journal (2). The report indicates although awareness of cardiovascular problems has increased, awareness campaigns have not always paid attention to assessment of risk and sex specific risk factors. Consequently, cardiovascular disease in women remains under-recognised and therefore under treated. This report was authored by leading female experts from 11 countries and outlines 10 recommendations to address the sex differences seen around the world in assessment, treatment, and awareness of cardiovascular disease in women.
A key message from the report was to develop educational programmes on cardiovascular disease in women for health professionals as well as the general community. Indeed, this opinion is echoed by other experts who call for urgent action to improve care, prevent disease and increase awareness of cardiovascular disease in women.
In addition to this, a broader approach to women’s health is recommended in order to improve the assessment of heart disease and cardiovascular health such as combining routine health checks women undertake (3). An example is creating comprehensive health service centres for women where women can have a heart health check and breast screening at the same appointment.
Her Heart has been advocating for Women’s Heart Health, and has agitated for increased (tailored) Heart Health Campaigns for women, robust educational programs and training programs for medical, nursing and allied health professions. This Lancet Report is clear in its message – and is summarised by the lead author Prof Mehran: “When you look specifically at women and cardiovascular disease risk, we need to better understand links with stress and mental health, and also the reality that for many young women, their chest pain relates to ischaemia, even if it does not show up on an angiogram; we need to better understand the pathophysiology of the female heart. At a broader level, we need to help women appreciate that there are many points along the lifespan where interventions can improve cardiovascular health. But only when we recruit more women into clinical trials can we establish clear, women focused clinical guidelines. It’s time we stopped talking about it, and took urgent action” (3)
- Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70: 1–25
- Vogel, B et al (2021). The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030 accessed from https://doi.org/10.1016/ S0140-6736(21)00684-X
- Perspectives: Roxana Mehran: driving force in women’s cardiovascular health (2021) accessed from https://doi.org/10.1016/ S0140-6736(21)01100-4