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Addressing Cardiovascular Risk Across the Arc of a Woman’s Life: Sex-Specific Prevention and Treatment

  • Women and Cardiovascular Health (N Goldberg and S Lewis, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in women in the United States of America. Despite this, women are underdiagnosed, less often receive preventive care, and are undertreated for CVD compared to men. There has been an increase in sex-specific risk factors and treatments over the past decade; however, sex-specific recommendations have not been included in the guidelines. We aim to highlight recent evidence behind the differential effect of traditional risk factors and underscore sex-specific risk factors with an intention to promote awareness, improve risk stratification, and early implementation of appropriate preventive therapies in women.

Recent Findings

Women are prescribed fewer antihypertensives and lipid-lowering agents and receive less cardiovascular care as compared to men. Additionally, pregnancy complications have been associated with increased cardiovascular mortality later in life. Findings from the ARIC study suggest that there is a perception of lower risk of cardiovascular disease in women. The SWEDEHEART study which investigated sex differences in treatment, noted a lower prescription of guideline-directed therapy in women. Women are less likely to be prescribed statin medications by their providers in both primary and secondary prevention as they are considered lower risk than men, while also being more likely to decline and discontinue treatment. A woman’s abnormal response to pregnancy may serve as her first physiological stress test which can have implications on her future cardiovascular health. This was supported by the CHAMPs study noting a higher premature cardiovascular risk after maternal complications. Adverse pregnancy outcomes have been associated with a 1.5–4.0 fold increase in future cardiovascular events in multiple studies.

Summary

In this review, we highlight the differences in traditional risk factors and their impact on women. Furthermore, we address the sex-specific risk factors and pregnancy-associated complications that increase the risk of CVD in women. Adherence to GDMT may have implications on overall mortality in women. An effort to improve early recognition of CVD risk with implementation of aggressive risk factor control and lifestyle modification should be emphasized. Future studies should specifically report on differences in outcomes between males and females. Increased awareness and knowledge on sex-specific risks and prevention are likely to lower the prevalence and improve outcomes of CVD in women.

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Abbreviations

ACC:

American college of cardiology

AHA:

American heart association

ARIC:

Atherosclerosis risk in communities study

ASCVD:

Atherosclerotic cardiovascular disease

BP:

Blood pressure

BMI:

Body mass index

CAC:

Coronary artery calcium

CARDIA:

Coronary artery risk development in young adults

CHAMPS:

Cardiovascular health after maternal placental syndrome

CVD:

Cardiovascular disease

DM:

Diabetes mellitus

ESC:

European society of cardiology

FHS:

Framingham heart study

GDM:

Gestational diabetes mellitus

GLP-1:

Glucagon-like peptide-1

LDL:

Low-density lipoprotein

LVEF:

Left ventricular ejection fraction

MESA:

Multi-ethnic study of atherosclerosis

OCP:

Oral contraceptive pills

PCOS:

Polycystic ovary syndrome

RCT:

Randomized clinical trial

SGA:

Small for gestational age

SLE:

Systemic lupus erythematosus

SPRINT:

Systolic blood pressure intervention trial

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Authors and Affiliations

  1. Section of Non-Invasive Cardiology, Division of Cardiovascular Medicine, Department of Medicine, NCH Rooney Heart Institute, 34102, Naples, FL, USA

    Dhiran Verghese, Laura Muller & Shona Velamakanni

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  1. Dhiran Verghese
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  2. Laura Muller
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  3. Shona Velamakanni
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Correspondence to Shona Velamakanni.

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Verghese, D., Muller, L. & Velamakanni, S. Addressing Cardiovascular Risk Across the Arc of a Woman’s Life: Sex-Specific Prevention and Treatment. Curr Cardiol Rep 25, 1053–1064 (2023). https://doi.org/10.1007/s11886-023-01923-5

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