Urgent action is needed to improve care and prevention, fill knowledge gaps, and increase awareness about cardiovascular disease in women, according to a new report from the Lancet Commission. The first-ever global report on women and cardiovascular disease was published May 16 in The Lancet and presented during ACC.21.

Authored by 17 leading female experts from 11 countries, the report outlines 10 recommendations to tackle inequities in diagnosis, treatment, and prevention to reduce cardiovascular disease in women by 2030 – in line with the United Nations' broader Sustainable Development Goals (SDGs) to reduce premature deaths from noncommunicable diseases. The recommendations include educating health care providers and patients on early detection to prevent cardiovascular disease in women; scaling up heart health programs in highly populated and underdeveloped regions; and prioritizing sex-specific research on cardiovascular disease in women and intervention strategies.

"Cardiovascular disease in women remains understudied, under-recognized, under-diagnosed, and under-treated globally," said Roxana Mehran, MD, FACC, one of the authors. "Achieving the important target set by the United Nations requires bold, distinct strategies to not only target factors contributing to cardiovascular disease but also to identify sex-specific biological mechanisms in women. Making permanent improvements to the worldwide care of women with cardiovascular disease requires coordinated efforts and partnerships involving policymakers, clinicians, researchers, and the wider community."

The Commission report is based on data from the 2019 Global Burden of Disease Study, which showed approximately 275 million women around the world with cardiovascular disease in 2019 alone, with global age standardized prevalence estimated at 6,402 cases per 100,000. The leading cause of death in women worldwide was ischemic heart disease (47% of cardiovascular disease deaths), followed by stroke (36% of cardiovascular disease deaths).

The data also underscored considerable geographical differences in cardiovascular disease, with the highest age-standardized prevalence in Egypt, Iran, Iraq, Libya, Morocco and United Arab Emirates, while the countries with lowest prevalence were Bolivia, Peru, Colombia, Ecuador and Venezuela. Although globally the prevalence of cardiovascular disease in women has been declining, with an overall decrease of 4.3% since 1990, some of the world's most populous nations have seen an increase in cardiovascular disease, including China (10% increase), Indonesia (7% increase), and India (3% increase). The highest cardiovascular disease mortality rates were in Central Asia, Eastern Europe, North Africa, and the Middle East, Oceania and Central Sub-Saharan Africa, where age-standardized mortality exceeded 300 deaths per 100,000 women. High-income Asia Pacific, Australasia, Western Europe, Andean Latin America and High-income North America recorded the lowest rates.

The evidence of important regional trends suggests a need for improved data collection at local and regional levels to effectively prevent, recognize, and treat cardiovascular disease in women, the authors said. They also note the importance of addressing established risk factors like hypertension, body mass index and high LDL cholesterol, but also said sex-specific risk factors such as premature menopause and pregnancy related-disorders must be more widely recognized and prioritized as part of treatment and prevention efforts worldwide. They also stress the importance of paying attention to socioeconomic and cultural factors, as well as mental health, in prevention and management of cardiovascular disease.

"While some risk factors for cardiovascular disease are similar for women and men, women are more likely to suffer from health disparities due to cultural, political or socioeconomic factors," said C. Noel Bairey Merz, MD, FACC, another author of the report. "For instance, some social or religious norms – such as restrictions on participation in sport and physical activities – can contribute to cardiovascular disease in women, highlighting an urgent need for culturally appropriate initiatives that are tailored to different regions and populations."

The Commission also highlights the need to increase awareness of cardiovascular disease risk in women among physicians, scientists, and health care providers. The authors point out the unmet need for cardiovascular disease prediction models that include sex-specific risk factors, as well as greater inclusion of women in clinical trials. Tailored interventions for the most vulnerable populations globally, including women from minority or indigenous populations and those whose roles in society are strongly defined by traditional or religious norms, as well as those not typically viewed as being at high risk, such as young women, are also important.

In a related editorial, Ana Olga Mocumbi, MD, of the Mozambique National Institute of Health, writes: "In the midst of the COVID-19 pandemic, values of human dignity, solidarity, altruism, and social justice should guide our communities to ensure equitable share of wealth and leveraging of efforts towards the reduction of cardiovascular disease burden in women worldwide. The Commission's recommendations on additional funding for women's cardiovascular health programs, prioritization of integrated care programs, including combined cardiac and obstetric care, and strengthening of the health systems accords with efforts to bridge the gap for the world's worst off. Such a shift in women's cardiovascular care would be a major step towards equity, social justice, and sustainable development."

Clinical Topics: COVID-19 Hub, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Hypertension

Keywords: ACC Annual Scientific Session, ACC21, ACC International, Female, Cholesterol, LDL, Mental Health, Vulnerable Populations, COVID-19, Hypertension, Socioeconomic Factors, Stroke, Myocardial Ischemia

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