10 takeaways from the past decade in women's cardiovascular care

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 - Doctor with woman

A newly published article in the Journal of Women’s Health by Pejman Raeisi-Giglou, DO, and colleagues examined advances in women’s cardiovascular care over the past 10 years, highlighting the most significant accomplishments and pointing out persisting gender gaps. These are 10 key points from their article:

1. Awareness of cardiovascular disease (CVD) in women has jumped more than 32 percent over the past 10 years.

In 1997, Raeisi-Giglou and co-authors wrote, awareness of CVD in women was recorded at a meager 24 percent. By 2012, that number had climbed to 56 percent, and it keeps growing due to media coverage, government support, education and organizations dedicated to preventing and treating heart disease in women.

2. We know a lot more about nontraditional cardiovascular risk factors than a decade ago.

Known CVD risk factors—such as diabetes, hypertension and obesity—still affect women, but scientific advances in the past 10 years have allowed doctors to identify, treat and take preventative measures against nontraditional risk factors like autoimmune disorders, obstructive sleep apnea, radiation-induced myocardial injury, gestational diabetes and hypertension, and preeclampsia, Raeisi-Giglou and co-authors noted. The addition of dedicated women’s heart centers at tertiary-care hospitals, community-based approaches for risk prevention and preventative healthcare screenings have also contributed to the increase in knowledge that has slashed mortality rates.

3. Drug guidelines and therapies specific to women have been developed.

Much of secondary prevention of CVD includes use of pharmacotherapy, Raeisi-Giglou and colleagues wrote, which encompasses aspirin, statins, beta-blockers and angiotensin-converting enzyme inhibitors. Starting in 2008, scientists began conducting sex-specific studies focusing on the effectiveness of drugs and their side effects in women, leading to the knowledge that aspirin can reduce CVD mortality in postmenopausal women, and that taking statins can reduce heart disease in female patients. Still, women are less likely to receive aggressive care or be referred for cardiac rehabilitation than men.

4. Scientists have identified stroke symptoms and risk factors unique to female patients.

While focal neurologic deficits, cardiovascular disease, high blood pressure and tobacco use are proven and prevalent risk factors for stroke in men, doctors know less about what causes the disease in women. Over the past 10 years, however, researchers have been able to identify and treat, several sex-specific factors during that decade, including mental status changes, older age, atrial fibrillation congestive heart failure, preeclampsia, pregnancy-related hypertension and metabolic syndrome. Women are still less likely than men to be prescribed statins, aspirin or thrombolytics, and they’re more likely to witness a delay in treatment, Raeisi-Giglou and co-authors wrote.

5. We know more about peripartum cardiomyopathy.

Peripartum cardiomyopathy is a rare condition characterized by left ventricular systolic function during the peripartum portion of a pregnancy. It may only affect one of 7,500 pregnancies in the U.S., but little was known about the complication other than its basic risk factors. The past 10 years have seen advances in this field, including the knowledge that anemia, reactive airway disease, autoimmune diseases and drug abuse can contribute to the problem.

6. Doctors have made strides in figuring out why heart failure with preserved ejection fraction (HFpEF) occurs more in women than it does in men.

HFpEF is on the rise, Raeisi-Giglou and colleagues wrote, and the disease, which is often also accompanied by hypertension, chronic obstructive lung disease and diabetes, remains more prevalent in women than in men. Pathologic data developed over the past 10 years has suggested HFpEF patients have more cardiac hypertrophy, cardiac fibrosis and lower microvascular density than do populations without the disease. Doctors have been able to identify helpful treatments specific to women.

7. We’ve learned that 50 percent of women undergoing cardiac catheterization for ischemia have nonobstructive disease, compared to just 17 percent of men.

These numbers are based on previous research, but scientists still don’t know a lot about this. What they do know is that women with no significant heart disease are more likely to have chest pain associated with ischemia than men. Researchers have discovered symptomatic women with ischemia and nonobstructive coronary artery disease have a higher mortality rate than asymptomatic women with no known heart disease, suggesting women in the former situation may need additional surveillance.

8. It’s become clear there needs to be more research in spontaneous coronary artery dissection (SCAD) in young women.

While SCAD affects less than 5 percent of all patients undergoing coronary artery catheterization, it’s more likely to affect young women, Raeisi-Giglou and co-authors wrote, and though in-hospital mortality is low, recurrence of the condition and risk of major adverse cardiac events is very possible. Despite these risks, no guideline-directed therapies for SCAD exist right now. Factors thought to contribute to SCAD include extreme emotional stress, extreme exertion, fibromuscular dysplasia and pregnancy, all of which greatly affect women.

9. Researchers have been underrepresenting women in clinical trials dealing with cardiac electrophysiology, despite recent research suggesting women respond better to that type of care.

It’s well-established that women and men react differently to cardiac electrophysiology, largely due to different resting heart rates (women’s are generally higher), varying QT intervals (women’s are longer) and different survival benefits. Still, Raeisi-Giglou and colleagues identified significant underutilization of devices like cardiac resynchronization therapy, which has proven to be more successful in women and lead to reduced hospitalizations, among other benefits.

10. We’re learning that we need to amp up treatment for atrial fibrillation (AFib) in women.

Almost 16 million U.S. citizens are expected to be living with AF by the year 2050, according to Raeisi-Giglou’s research. While AF is more common in men, once patients hit 75 years old, 60 percent of individuals who develop AF are women, and “female gender” has been marked as a parameter for stroke risk assessment. Despite this, women are less likely to receive anticoagulation, ablation procedures, rhythm control and electrical cardioversion than are men in the same situation. Women are more also likely to be rehospitalized for AFib within a year after an ablation procedure.

Raeisi-Giglou and co-authors wrote that while the past 10 years have seen significant advances in biomedical research unique to women, there’s still a way to go.

“This momentum should be continued as work still needs to be done to close remaining gender gaps in CV healthcare through new knowledge, advocacy, community education and the inclusion of greater numbers of women in clinical trials,” they wrote. “Working together, researchers, healthcare professionals, advocates and women living with heart disease can contribute to further progress in prevention, early detection, accurate diagnosis and proper treatment for women with or at risk for CVD.”