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Secondary Prevention of Cardiovascular Disease in Women: Closing the Gap
Aarti Thakkar1, Anandita Agarwala2, Erin D Michos1
1Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine Baltimore, MD, US.
Insights
Cardiovascular disease (CVD) in women, especially younger women, requires better diagnosis and treatment. Improving guideline-directed medical therapy (GDMT) and cardiac rehabilitation access can reduce mortality in women.
Area of Science:
- Cardiology
- Women's Health
- Preventive Medicine
Background:
- Cardiovascular disease (CVD) is the leading global cause of death in women.
- Younger women (<55 years) with myocardial infarction (MI) receive less guideline-directed medical therapy (GDMT), have higher readmission rates, and increased mortality compared to men.
- Underrepresentation of women in clinical trials limits the generalizability of CVD research findings.
Purpose of the Study:
- To highlight disparities in cardiovascular disease (CVD) care for women.
- To review the efficacy of secondary prevention therapies in women.
- To emphasize the need for sex-specific CVD guidelines and improved management strategies.
Main Methods:
- Literature review of existing evidence on CVD in women.
- Analysis of treatment patterns and outcomes in female versus male patients.
- Examination of enrollment rates in cardiac rehabilitation programs.
Main Results:
- Women experience similar benefits from pharmacological therapies (statins, ezetimibe, PCSK9 inhibitors, icosapent ethyl, antiplatelet therapy, SGLT2 inhibitors, GLP-1 RAs) as men.
- Women are less likely to be enrolled in cardiac rehabilitation programs.
- Disparities exist in GDMT receipt and outcomes for younger women post-MI.
Conclusions:
- Optimizing CVD management in women requires accurate identification, appropriate GDMT, and lifestyle modification promotion.
- Further research is needed to develop sex-tailored CVD guidelines.
- Closing the gap in diagnosis, treatment, and mortality for women with CVD is crucial.
Abstract:
Cardiovascular disease (CVD) remains the leading cause of death in women globally. Younger women (<55 years of age) who experience MI are less likely to receive guideline-directed medical therapy (GDMT), have a greater likelihood of readmission and have higher rates of mortality than similarly aged men. Women have been under-represented in CVD clinical trials, which limits the generalisability of results into practice. Available evidence indicates that women derive a similar benefit as men from secondary prevention pharmacological therapies, such as statins, ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitors, icosapent ethyl, antiplatelet therapy, sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists. Women are less likely to be enrolled in cardiac rehabilitation programs than men. Mitigating risk and improving outcomes is dependent on proper identification of CVD in women, using appropriate GDMT and continuing to promote lifestyle modifications. Future research directed at advancing our understanding of CVD in women will allow us to further develop and tailor CVD guidelines appropriate by sex and to close the gap between diagnoses, treatment and mortality.
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