Federal and American Heart Association AHA initiatives to raise awareness and to reduce gender disparities in research and clinical care are listed in Table 1. There was a near doubling of the rate of awareness of heart disease as the leading cause of death in women betweensex and cardiovascular disease, when the Sex and cardiovascular disease launched its first campaign for women, and ; during that same period, the death rate resulting from CVD decreased by nearly half.
Recommendations for the design and analyses of future CVD clinical trials in women are also provided. Progress, sex and cardiovascular disease, Pitfalls, and Promise.
National Academies Press; The absolute numbers of women living with and dying of CVD and stroke exceed those of men, as does the number of hospital discharges for heart failure and stroke. Because female sex is associated with a longer life expectancy than male sex, women constitute a larger proportion of the elderly population in which the prevalence of CVD is greatest.
Alarming statistics among younger women 35 to 44 years of age show that CHD mortality rates have increased an average sex and cardiovascular disease 1.
Annual number of adults having diagnosed heart attack or fatal coronary heart disease CHD by age and sex. Reprinted with permission of the publisher. Heart Disease and Stroke Statistics— Update: As illustrated in Figure 2 the absolute number of annual CVD deaths among the female sex has exceeded that of the male sex since These data are often thirst and weight loss in cats with CVD mortality rates, which, when adjusted for differences in age distribution, reveal that the CVD mortality rate is substantially sex and cardiovascular disease in men than women Table 2.
Inthe age-adjusted CVD death rate in men was per compared with per women. From tothe age-adjusted death rate for CHD fell from to per women; during the same time period, the rate fell from to per men.
Trends in the total annual number sex and cardiovascular disease deaths caused by cardiovascular disease according to gender, sex and cardiovascular disease, United States, to Dr Bernadine Healy first introduced the concept of the Yentl syndrome insuggesting gender vitamin c and red blood cells in the management of CHD.
Is any observed difference explained by delay in women seeking care, healthcare provider delay in recognition and treatment, underlying differences in pathophysiology, more comorbidities, or older ages at time of presentation among women compared with men? Data over the past decade have shown that women have a higher day mortality compared with men, and it is now recognized that the gender differences are largely explained by clinical differences at presentation.
The classic risk factors for CVD are the same in women and men, but there are gender differences in the prevalence of risk factors. Lifestyle risk factors also vary by gender, race, and ethnicity. Cigarette smoking has decreased overall in the United States, but remains more common among men than women Age-adjusted rates of physical inactivity in were higher in women than men From tothe increase in the prevalence of obesity was greater among men than women.
Sex and cardiovascular disease data suggest that population-wide approaches are needed to reduce the burden of CVD in both genders.
Arguably, a major explanation for the decline in Sex and cardiovascular disease death rates for women and men has been widespread application of evidence-based preventive strategies.
An analysis from the Centers for Disease Control concluded that approximately half of the improvement in CHD death rates in the United States from and was due to better control of major risk factors, including reductions in total cholesterol, systolic blood pressure, and smoking prevalence. Inthe AHA issued the first evidence-based guidelines for CVD sex and cardiovascular disease in women derived from a systematic search and review of the scientific literature designed to identify whether gender differences were present in response to preventive therapies.
A update of the guidelines concluded that the evidence documented few gender differences in the efficacy of preventive interventions, but data evaluating parity in safety or cost-effectiveness were limited.
Table 3 lists key clinical questions concerning CVD prevention in women that were unanswered in During sex and cardiovascular disease past decade, landmark clinical trials have transformed the practice of CVD prevention in women and men. A meta-analysis of randomized controlled trials of aspirin available to supported the use of low-dose aspirin to prevent CVD in both high-risk men and women.
The AHA suggests that aspirin to prevent CVD in older women be considered as long as blood pressure is controlled and the potential benefits are likely to outweigh potential risks. Based on a wealth of epidemiological data and support from basic science, there was widespread interest in the s in evaluating the use of vitamin supplements for CVD prevention.
The overwhelming majority of participants in early clinical trials were men. More data on the role of omega-3 supplementation in primary prevention are expected from the Vitamin D and Omega-3 Trial VITALwhich began recruitment of 20 US men and women in January to test whether daily supplements of vitamin D IU cholecalciferol or fish oil 1 g omega-3 fatty acids reduce the risk of CVD and cancer.
The benefit of secondary prevention associated with a reduction of low-density lipoprotein cholesterol levels in both women and men is well established. The proportional reduction in vascular risk has been linked to the absolute reduction in low-density lipoprotein cholesterol achieved regardless of initial level of low-density lipoprotein cholesterol and is similar for women and men. The hazard reduction was similar for women and men, although the absolute sex and cardiovascular disease in women was lower, reflecting their lower baseline risk.
The methods and results of the JUPITER trial have fueled the ongoing debate on gender differences in the use of statins for primary prevention.
Adherence to guidelines for the prevention of CVD is suboptimal for women and men. The extent to which physician behaviors, patient behaviors, and environmental factors explain nonadherence is not established, sex and cardiovascular disease.
The limited systematic evaluation of provider performance in CVD preventive care makes it difficult to document gender differences in the delivery of care. Etiologic explanations for any observed gender differences in adherence to preventive recommendations are even more elusive. Most studies are conducted in select settings, use a variety of quality indicators, and report limited data on confounding or effect-modifying variables.
Despite these research limitations, several themes consistently emerge regarding barriers to optimal preventive care. A fundamental barrier to implementation of prevention guidelines may be the guidelines themselves. Shaneyfelt et al 62 evaluated the guidelines process and found that longer guidelines included more standards than shorter guidelines but were more often ignored in practice, sex and cardiovascular disease.
Evidence-based recommendations were used more often than recommendations for practice not based on research evidence, and controversial recommendations were followed less often than those that were noncontroversial.
Cabana et al 66 evaluated 76 studies describing barriers to adherence to clinical practice guidelines; lack of awareness, lack of familiarity, lack of agreement, lack of self-efficacy, lack of outcome expectancy, and inertia of previous practice were recurring thematic barriers for following guidelines.
It was suggested that AHA guidelines for the prevention of CVD in women are heterogeneous, and consequently there are different barriers to implementation of individual recommendations. A subanalysis of this study suggested that solo practitioners and older physicians should be targeted to help promote the use of the guidelines.
For example, depression and social isolation have been linked to CVD risk and may be mediated by nonadherence to preventive recommendations, although there is a lack of clinical trials to document that treatment of psychosocial risk improves patient outcomes. Systems approaches to CVD prevention have the potential to improve outcomes and to reduce disparities, sex and cardiovascular disease. The Get With the Guidelines Quality Sex and cardiovascular disease Program has shown improved adherence to secondary prevention guidelines over time for both women and men, but the data are subject to selection bias and secular trends.
Progress in the inclusion of women in CVD trials sex and cardiovascular disease divergent interpretations. A study conducted in of NHLBI-funded studies of CVD concluded that federal efforts to increase the representation of women in clinical trials had been moderately successful, primarily because of the initiation of a small number of large single-sex trials that enrolled women.
It also noted little progress in the sex composition of cohorts in the majority of CVD studies. The lack of gender-specific safety and effectiveness is a barrier to optimal CVD care for women.
More research has to be conducted on effective lifestyle methods to prevent CVD, especially those approaches that have the potential for long-term sustainability among diverse groups of women. Table 4 lists recommendations for the design, conduct, and reporting of future CVD trials in women. It will be important to determine to what extent these data and their dissemination can reduce gender disparities in preventive care and improve clinical CVD outcomes for women, sex and cardiovascular disease.
We wish to thank Lisa Rehm for her assistance with literature searches and manuscript submission. Gender is shaped by environment and experience. Sex is the classification of female or male according to reproductive organs and functions assigned by chromosomal complement. Drs Mosca and Wenger were members of the AHA expert panel on the prevention of heart disease in women.
National Center for Biotechnology InformationU, sex and cardiovascular disease. Author manuscript; available in PMC Nov 8. See other articles in PMC that cite the published article. Open in a separate window.
Transformative CVD Prevention Research Arguably, a major explanation for the decline in CVD death rates for women and men has been widespread application of evidence-based preventive strategies. Folic acid and B vitamin weight loss and cardiac exersize do not prevent incident or recurrent CVD 43 — 47 Does omega-3 fatty acid supplementation prevent incident or recurrent CVD?
Omega-3 might prevent CVD in women with hypercholesterolemia but the absolute benefit is low 48 — 51 Does vitamin D and calcium supplementation prevent incident or recurrent CVD? LDL reduction reduces recurrent events and might reduce incident events in women, but the absolute benefit for primary prevention is small 55 — Acknowledgments We wish to thank Lisa Rehm for her assistance with literature searches and manuscript submission.
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