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Cardiovascular disease in women: implications for improving health outcomes
Patricia M Davidson1, Julie Anne Mitchell, Michelle DiGiacomo
1Centre for Cardiovascular and Chronic Care, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Australia. patriciamary.davidson@uts.edu.au
Insights
Women experience worse cardiovascular disease outcomes than men, particularly with acute coronary syndromes. Addressing these disparities requires a better understanding of women's specific health needs and improved interventions.
Area of Science:
- Cardiology
- Public Health
- Sex Differences in Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of death globally, with significant sex-based disparities in outcomes.
- Women often present with different symptoms and have unique risk factors compared to men, necessitating tailored approaches.
- Existing research highlights poorer outcomes for women in various cardiovascular conditions, underscoring a critical knowledge gap.
Purpose of the Study:
- To synthesize current data on cardiovascular disease in women globally and in Australia.
- To identify key areas for improving public health campaigns and clinical interventions for women's cardiovascular health.
Main Methods:
- A comprehensive literature review was conducted to collate existing data.
- Analysis focused on identifying sex differences in cardiovascular disease presentation, risk factors, management, and outcomes.
Main Results:
- Women with acute coronary syndromes (ACS) exhibit poorer outcomes than men, irrespective of comorbidities or treatment, despite less severe coronary artery obstruction.
- Higher mortality and complication rates are noted in younger women and those with ST-elevation myocardial infarction (STEMI).
- Sex-specific differences in atherogenesis, cardiovascular adaptation, stroke risk with atrial fibrillation, and risk factor profiles (especially postmenopause) are observed, alongside sociocultural influences and healthcare system factors contributing to disparities.
Conclusions:
- A comprehensive understanding of women's specific cardiovascular needs is essential for community, healthcare professionals, researchers, and policymakers.
- Targeted interventions and improved prevention strategies are crucial to mitigate the disproportionate burden of cardiovascular disease in women.
- Increased representation of women in clinical trials is vital to generate evidence-based guidelines for their care.
Objective:
To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions.
Design:
Literature review.
Results:
Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials.
Conclusions:
Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government.
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