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Is cardiovascular disease in women inevitable?: preparing for menopause and beyond
Jimmy Johannes1, C Noel Bairey Merz
1Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA 90048, USA.
Insights
Cardiovascular disease (CVD) remains a leading cause of death for women, with a significant mortality gap compared to men. Awareness and female-specific guidelines are improving, but menopause
Area of Science:
- Cardiology
- Women's Health
- Epidemiology
Background:
- Cardiovascular disease (CVD) is the primary cause of death for American women.
- A significant sex-based CVD mortality gap exists, with women experiencing higher mortality rates than men since 1984.
- Risk factors for CVD are age-associated, and their prevalence increases with age in both sexes.
Purpose of the Study:
- To examine the trends in CVD mortality in women compared to men.
- To investigate the role of awareness and specific guidelines in addressing CVD risk in women.
- To clarify the controversial relationship between menopause and CVD risk.
Main Methods:
- Analysis of CVD mortality trends in men and women over time.
- Review of the impact of awareness campaigns and female-specific guidelines.
- Evaluation of the association between menopause, aging, and CVD risk.
Main Results:
- Women's CVD mortality increased until 2000, contributing to a widening mortality gap compared to men.
- Awareness campaigns and guidelines show promise in improving CVD risk recognition among women.
- Current evidence suggests menopause does not independently increase CVD risk beyond aging, and hormone therapy is not effective for secondary prevention.
Conclusions:
- Addressing the CVD mortality gap in women requires continued focus on awareness and tailored prevention strategies.
- The impact of menopause on CVD risk is complex and largely confounded by age.
- Further research is needed to optimize CVD prevention and treatment for women, considering their unique risk profiles.
Abstract:
Cardiovascular disease (CVD) is the leading cause of death for American women. Women share many of the same risk factors (RFs) for CVD as men, and in both, women and men, these RFs are associated with age. Additionally, the prevalence of multiple RFs increases with age. Though menopause has been thought to increase CVD risk in women, the association between menopause and age obfuscates a causal relationship. While men's CVD mortality has decreased since the 1980s, women's CVD mortality has climbed until 2000. This has resulted in a sex-related CVD mortality gap, with women having higher mortality than men since 1984. Contributing to this female-majority CVD mortality gap is a lack of awareness of CVD risk among women and their physicians. Awareness campaigns, such as the Heart Truth and the Red Dress symbol, appear to have improved recognition of CVD risk in women. Further, female-specific guidelines have been developed to prevent and reduce CVD in women. Though the current understanding of the role of menopause in CVD is controversial, studies suggest that menopause does not exacerbate CVD independent of aging, and hormone replacement therapy is not effective for secondary prevention of CVD.
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