An expert panel convened by The Lancet calls for urgent measures to reduce the global burden of cardiovascular disease (CVD) on women and has outlined an ambitious agenda to achieve this goal.
The report, from the Lancet Commission on Women and Cardiovascular Disease, led by women, was presented on May 16 during a plenary session at the American College of Cardiology (ACC) 2021 scientific session and simultaneously published online inside The Lancet.
MCV is the leading cause of death in women worldwide. An estimated 275.2 million women are diagnosed with heart disease worldwide, including 20.8 million in the United States, and most of these cases are preventable, the authors write.
Decades of grassroots campaigns have raised awareness about the impact of MCV on women and the positive changes affecting women and their health have gained momentum. However, the last decade has seen “stagnation” in the overall reduction in the burden of cardiovascular disease on women, the group notes. Cardiovascular disease in women remains poorly studied, recognized, diagnosed, and treated.
“For the first time, we are trying to gain a full understanding of what it can mean to reduce heart disease among women around the world. This problem has persisted unchanged for decades, and this commission is a critical step toward finding solutions. “said Roxana Mehran, MD, who led the effort, said in a press release.
“For example, doctors are aware of this hypertension, smoking, hyperlipidemia, and diabetes are the most important risk factors for evidence-based heart disease. We now need to focus our study on lesser-known risk factors that affect women’s health, ”said Mehran, director of Interventional Cardiovascular Research and Clinical Trials at Mount Sinai’s Icahn School of Medicine in the city of New York.
These include the “pronounced but little-studied role” of stress, psychosocial and economic deprivation, as well as risk factors for sex-specific cardiovascular disease, such as premature birth, preeclampsia, premature menopause, and domestic violence, Mehran said.
“The commission concludes that by studying such factors, we can better prevent, identify and treat heart disease, reduce mortality rates and improve women’s health globally,” Mehran said.
Key messages and recommendations
1. There are no accurate data on the global prevalence and outcomes of CVD in women.
Recommendation: Direct funding for accurate and real-time data collection on the prevalence and outcomes of cardiovascular disease in women worldwide.
2. Women with CVD continue to be poorly studied, recognized, diagnosed, and treated.
Recommendation: Develop educational programs on MCV in women for physicians, scientists, allied health professionals, and communities.
3. The specific mechanisms of sex in the pathophysiology and natural history of CVD are still poorly understood.
Recommendation: Prioritize gender-specific research focused on the identification of the pathophysiology and natural history of CVD.
4. Women are underrepresented in most CV clinical trials.
Recommendation: Develop strategies to improve the enrollment and retention of women in CV clinical trials.
5. Socio-economic deprivation contributes substantially to the global burden of cardiovascular disease on women.
Recommendation: Prioritize funding to global health organizations for cardiovascular disease health programs in women from socioeconomically poor regions.
6. Myocardial infarction and CVD mortality increases in young women.
Recommendation: Educate health professionals and patients on the early detection and prevention of cardiovascular disease in young women.
7. Hypertension, dyslipidemia, and diabetes are the most important risk factors contributing to death from cardiovascular disease for women.
Recommendation: Establish initiatives based on MCV risk factor policies and programs for medical and community outreach in environments frequented by women.
8. Risk factors for sex-specific and other unrecognized cardiovascular disease, such as psychosocial and socioeconomic factors, appear to contribute to the overall burden of cardiovascular disease on women.
Recommendation: Research is needed to identify the effect of gender-specific, psychosocial, and socioeconomic risk factors on CVD in women and to evaluate intervention strategies.
9. The prevalence of age-adjusted MCV in women is increasing in some of the most populous countries in the world.
Recommendation: Expand healthy heart programs in densely populated and progressively industrialized regions.
10. There is currently no established global policy to coordinate the prevention and treatment of cardiovascular disease in women.
Recommendation: Embrace public-private partnerships to develop large-scale programs to save the lives of women with cardiovascular disease.
“These recommendations are a roadmap for fighting this number 1 female killer around the world,” Mehran said.
“It is a far-reaching and far-reaching company and will require a full commitment from governments, healthcare organizations, technology sectors and funding agencies to prioritize this urgent need for change. We hope this roadmap is the northern star of the future of women’s heart health, ”she added.
“Establishing these recommendations is an important step, but it’s even more important how the ten key messages are implemented pragmatically in specific real-life settings,” said Valentin Fuster, MD, PhD, director of the Mount Sinai Heart and Physician at none, Mount Sinai Hospital said in the press release.
It’s also important to develop “motivational programs to prevent heart disease from early childhood and for women before and during pregnancy,” Fuster said.
In a Lancet Comment, Ana Olga Mocumbi, MD, PhD, National Institute of Health of Mozambique, who did not participate in the commission, says her recommendations call for additional funding for women’s CV health programs, prioritizing integrated care programs , including combined cardiac and obstetric care strengthening health systems, aligning with efforts to “bridge the gap of the world’s poorest.”
“This change in women’s cardiovascular care would be an important step towards equity, social justice and sustainable development,” Mocumbi writes.
The Lancet Women and Cardiovascular Disease Commission received financial support from grants from Abbott Vascular, Abiomed, Amgen, AstraZeneca, Bristol Myers Squibb, CSL Behring, Janssen, Medtronic, Orbus Neich, Philips and Sanofi, which had no role in study design, data collection, data analysis, data interpretation or commission article writing. The funds were used for the planning, development and public launch of the commission article. None of the authors received any payment for their work on the commission.
Lancet. Published on May 16, 2021. Summary, Comment
Scientific Session of the American College of Cardiology (ACC) 2021. Presented May 16, 2021.