Despite being the cause of 35% of women’s deaths each year, women cardiovascular diseases (CVD) in women remain under-studied, under-recognized, under-diagnosed, and under-treated. Also, they are underrepresented in clinical trials, according to the first world report of these diseases in women.
Women remain under-studied, under-recognized, under-diagnosed, and under-treated in heart disease. In addition, they are underrepresented in clinical trials, according to the first world report of these ailments in women.
In order to address these inequalities, 17 experts from 11 countries have prepared this study on CVD in women, which has been published and promoted by the journal The Lancet. The document was presented during a plenary session at the 70th Annual Scientific Session of the American College of Cardiology (ACC.21).
In the Commission for the Cardiovascular Health of Women – created to carry out this report – the group of experts has formulated ten ambitious recommendations that help to improve diagnosis, the treatment and the prevention of cardiovascular diseases in women.
Among them, they stand out educate healthcare professionals and to patients in early detection to prevent heart disease in women; expand programs heart health in the most populated and developing regions; and prioritize sex-specific research on heart disease, as well as the development of intervention strategies for women.
According to the magazine, the objective of the commission is to help reduce global incidence of CVDs – including heart disease and the strokes, accounting for 35% of women’s deaths worldwide – by 2030. The initiative is in line with the United Nations Plan of Action for Sustainable Development.
Among the proposed measures, the experts emphasize educating health workers and patients on early detection; expand heart health programs in the most populated and underdeveloped regions; and prioritize sex-specific research on heart disease
The research professor Roxana Mehran, from Mount Sinai Medical Center (USA), points out that “to achieve the goal set by the United Nations, bold and different strategies are needed that not only focus on the factors that contribute to heart disease in women, but also identify the specific biological mechanismss of the female sex. We need to coordinate efforts and collaborations between policy makers, doctors, researchers and the community in general ”, he remarks.
In this sense, Sara cogliati, a researcher at the Severo Ochoa Molecular Biology Center (UAM-CSIC) —who does not participate in the study— tells SINC that “the launch of this commission of experts and the report are a fundamental step to improve the current situation in the study of heart disease in women ”. This commission “is very important because it gives precise and defined guidelines so that the world of basic and clinical research can move in a common field, organize their efforts and generate knowledge that will finally lead to a real advance in the treatment of these ailments in women ”, he continues.
Precisely, Cogliati is working on a project, funded by the L’Oréal-Unesco For Women in Science program, to study how mitochondria – the organs of cells responsible for supplying them with the energy they need – behave differently in men and women, which determines a different response during heart failure.
Prevalence and mortality
For their part, the report’s authors have reported data from the 2019 Global Burden of Disease Study for the first time to describe the extent of cardiovascular disease in women around the world, including prevalence, mortality and risk factors.
In 2019, there were approximately 275 million women worldwide with a CVD, with an age-standardized global prevalence estimated at 6,402 cases per 100,000. The leading cause of death from these diseases worldwide in 2019 was ischemic heart disease (47% of deaths, followed by ictus (36%).
The document highlights that there are considerable dgeographic differences in terms of heart disease, with the highest age-standardized prevalence in Egypt, Iran, Iraq, Libya, Morocco and the United Arab Emirates, while the countries with the lowest prevalence are Bolivia, Peru, Colombia, Ecuador and Venezuela.
The leading cause of death from these diseases worldwide in 2019 was ischemic heart disease (47% of deaths, followed by stroke (36%)
Although in the world the prevalence of CVD in women has been decreasing, with a global decrease of 4.3% since 1990, in some of the most populated countries there has been an increase, as is the case of China (10% increase), Indonesia (7%) e India (3 %). These increases indicate the need for initiatives to expand the prevention, diagnosis and treatment of cardiovascular diseases for women living in highly populated and industrialized regions.
CVD mortality rates are highest in Central Asia, Eastern Europe, North Africa and the Middle East, Oceania, and Sub-Saharan Central Africa, where age-standardized mortality exceeds 300 deaths per 100,000 women.
Asia-Pacific (high-income), Australasia, Western Europe, Andean Latin America, and North America (high-income) have the lowest rates, with fewer than 130 deaths per 100,000 women. Regional trends highlight the need to improve the data collection at the local level and regional to prevent, recognize and effectively treat CVD in women.
The authors point out that the arterial hypertension is the main risk factor that contributes to the loss of years of life due to CVD in women, followed by body mass index elevated and the cholesterol.
There are specific elements of risk, such as premature menopause and the pregnancy-related disorders, which should be more recognized and prioritized as part of treatment and prevention efforts around the world, they stress.
Some social or religious norms, such as restrictions on participation in sports and physical activities, can contribute to cardiovascular disease in women
Bairey Merz, a researcher at Cedars-Sinai Medical Center
Bairey merz, a researcher at the Cedars-Sinai Medical Center (USA) states: “Although some risk factors are similar for women and men, they are more likely to suffer health disparities due to issues cultural, political or socio-economic.
“For example, some social or religious norms, such as restrictions on participation in sport and physical activities, can contribute to CVD in women, highlighting the urgent need for culturally appropriate initiatives that are adapted to the different regions and populations ”, he emphasizes.
The need for tailor-made interventions
The authors suggest that measures to reduce heart disease should be tailored to the most vulnerable women of the world, like those of minority or indigenous populations and those whose roles in society are strongly defined by traditional or religious norms.
However, it is also important to reach groups that are not usually considered high risk, such as young women, a group in which the rates of heart attack and of smoking. In the last decade, 53 of the 195 countries and territories (27%) recorded significant decreases in the prevalence of smoking among men, while only 32 (16%) recorded significant reductions for women.
The authors recommend strategies to include more women in clinical trials, including addressing barriers to participation, such as family care issues, more inclusive enrollment criteria, and educating recruitment staff.
Despite the need to understand gender-related differences in optimal treatment and improved outcomes in patients of both genders, women have long been underrepresented in clinical trials. The experts recommend a series of strategies to include them, among others, addressing obstacles to participation, such as family care problems, adopting more inclusive enrollment criteria and educate recruitment staff on the importance of women’s participation in these trials.