The following are key points to remember from a state-of-the-art review addressing the global burden of cardiovascular disease (CVD) in women:

1. CVDs are the number one cause of death in women across the globe and despite small gains in CVD outcomes, women receive suboptimal care compared to men.
2. The top three CVDs among women include ischemic heart disease, peripheral artery disease, and stroke. Prevalence is highest in North Africa and the Middle East, high-income North America, and Eastern Europe with the lowest levels of disease in Andean, Southern, and Central Latin America. Global mortality rates are high with 204 women per 100,000 deaths from CVD.
3. The socioeconomic status of women can negatively affect their CV health and women experience lower socioeconomic status in most countries when compared to men. CVD risk factors are higher in socioeconomic deprivation for high income countries, but also occur in the setting of affluence in low- and middle-income countries.
4. The greatest contributors to CVD in women are socioeconomic resources and status, which can include factors from housing and nutrition to access to care; built environments, from access to green space, safety concerns, and indoor/outdoor air pollution; and food environments that negatively affect women, leading to obesity or malnutrition.
5. Sex differences enhance risk and create variable presentation of disease states. Women are more likely to have a wide range of symptoms and delays in seeking care. Unique to women are sex-related enhancing risk factors including disorders of pregnancy, autoimmune diseases, polycystic ovarian syndrome, and menopause.
6. Women in high-income countries experience the highest rate of death from CV conditions during pregnancy with disproportion affecting Black women in the United States.
7. Unfortunately, women experience less initiation of guideline-directed medical care and advanced therapy option offerings than men and therefore do not benefit from these often readily available and proven therapies for CVD.
8. There is a gap in knowledge in evidence-based CVD care due to underrepresentation of women in clinical trials, making application of results limited and often obtained from delayed observational data.
9. Strategies to close this gap in care must include a joint effort from various stakeholders: government and nongovernmental agencies—both nationally and at the community-level, health care systems, researchers, and an individual investment.
10. Finally, women must have a seat at the table for policy development, initiate active recruitment for training of women CV specialists, inclusion of women in research trials, community involvement that is culturally appropriate and sensitive to women’s unique needs, and standardized maternity care. The changes needed to reduce the risk of CVD and prevent CVD-related death in women are urgently needed across the globe.

Clinical Topics: Cardiovascular Care Team, Prevention

Keywords: Cardiovascular Diseases, Global Burden of Disease, Women's Health

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