Sex/Gender Differences in Cardiovascular Disease Prevention

Abstract

Over the past decade, scientists, healthcare providers, the public, and policy makers have made substantial efforts to improve understanding of the sex/gender* differences in cardiovascular disease (CVD)† and to recognize the importance of heart disease in women. 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 between 1997, when the AHA launched its first campaign for women, and 2009; during that same period, the death rate resulting from CVD decreased by nearly half.2–4 The extent to which efforts to close research gaps and to heighten awareness of heart disease in women are causally linked to lower CVD mortality or have resulted in improved clinical outcomes for women is not established. The purposes of this article are to evaluate contemporary sex/gender differences in the burden of CVD, to assess the impact of recent clinical trials on recommendations for the prevention of CVD in women, and to examine factors that may facilitate or impede quality CVD preventive care in women. Recommendations for the design and analyses of future CVD clinical trials in women are also provided.

Prediction of Cardiovascular Disease by the Framingham‐REGICOR Equation in the High‐Risk PREDIMED Cohort: Impact of the Mediterranean Diet Across Different Risk Strata

“…Although male sex is a well‐established risk factor,33 the proportion of deaths from cardiovascular causes is similar among European men and women (35% and 36%, respectively) aged <75 years 18. Concurring with prior studies,14, 34 the prevalence of high or very high risk among women was half that found in men (18% versus 36%), even though women were older by study design.…”

Cognitive Impairment and Risk of All‐Cause and Cardiovascular Disease Mortality Over 20‐Year Follow‐up: Results From the BLSA

“…In the present study, we found that males with reduced MMSE score had a higher risk of all‐cause mortality than females, and there was an interaction between sex and all‐cause mortality ( P =0.037 for interaction). This may be attributed to more‐traditional lifestyle risk factors among men than women, such as smoking, drinking, and physical inactivity, which contribute to both cognitive impairment and all‐cause mortality 26. However, women were more sensitive to the relationship between MMSE and CVD mortality.…”

Initiation Patterns of Statins in the 2 Years After Release of the 2013 American College of Cardiology/American Heart Association (ACC/AHA) Cholesterol Management Guideline in a Large US Health Plan

“…Despite evidence of the benefit of preventive statin use in women in the Management of Elevated Cholesterol in the Primary Prevention Group of Adult Japanese (MEGA) and Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trials, prescriber perception of a lower risk of cardiovascular disease for women has been shown to be a major barrier to the use of preventive strategies 14, 15, 16. Perceived or actual inconsistency in published cardiovascular disease prevention guidelines and lack of provider agreement with guidelines may also have contributed to the decreased use of statins in women 17…”