Promoting Cardiovascular Health in Midlife Women
Purpose of Review
Cardiovascular disease (CVD) remains the number one cause of death in the USA. In women, coronary heart disease (CHD) accounts for 22% of deaths with an additional 6.2% of deaths secondary to stroke. The prevalence of CVD increases as women age; after the age of 75, the incidence will exceed that reported for men. The risk for CVD in women is systematically underestimated. Both healthcare providers and women need a better understanding of the mechanism and role of traditional CVD risk factors (CVDRF) in women, and the newer identified non-traditional CVDRF which are unique to women and the resulting CVD morbidity and mortality.
Women with a CVD event often do not present the same as men. During middle-age and the transition to post-menopause, the complaints women experience often do not match the standard male-oriented CVD symptoms, and thus are often erroneously attributed to menopause. Unique sex-gene expression and function account for the biological variances in both CVDRF and CVD prevalence and presentation in women. There is a need for a more sex-specific approach to CVDRF assessment and targeted reduction in women.
There are major differences in the risk, development, and presentation of CVD in women. A wide-spread awareness is lacking in women and healthcare providers of the unique sex-specific differences in both CVDRF and CVD in women. The traditional CVD risk factor assessment tools and CVD risk calculators do not account for these differences and systematically underestimate CVD risk in women.
KeywordsCardiovascular disease in women Sex-specific cardiovascular disease risk Sex-specific cardiovascular disease symptoms Cardiovascular disease risk factors Non-traditional cardiovascular risk factors
Compliance with Ethical Standards
Conflict of Interest
Annette Jakubisin Konicki declares that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Heron M. Deaths: leading causes for 2016. Natl Vital Stat Rep. 2016;67(6).Google Scholar
- 3.•• Maffei S, Guiducci L, Cugusi L, Cadeddu C, Deidda M, Gallina S, et al. Women-specific predictors of cardiovascular disease risk - new paradigms. Int J Cardiol. 2019;286:190–7 This article identifies the sex-specific risk factors for cardiovascular disease and explores the possible correlation with events during a woman’s obstetric and gynecological history. PubMedCrossRefPubMedCentralGoogle Scholar
- 7.• Garcia M, Mulvagh SL, Merz CNB, Buring JE, Manson JE. Cardiovascular disease in women: clinical perspectives. Circ Res. 2016;118(8):1273–93 This article reviews both novel and unique aspects of the traditional and non-traditional risk factor in women for cardiovascular disease. Implications for screening, prevention, and treatment are also reviewed. PubMedPubMedCentralCrossRefGoogle Scholar
- 8.•• Cifkova R, Pitha J, Krajcoviechova A, Kralikova E. Is the impact of conventional risk factors the same in men and women? Plea for a more gender-specific approach. Int J Cardiol. 2019;286:214–9 This review analyzes sex-specific aspects of the traditional cardiovascular risk factors and the impact for cardiovascular disease in women. PubMedCrossRefPubMedCentralGoogle Scholar
- 11.• Maas AHEM. Maintaining cardiovascular health: an approach specific to women. Maturitas. 2019;124:68–71 This article reviews the sex-specific risk variable that are involved with non-obstructive and other types of ischemic heart disease seen more often in women. PubMedCrossRefPubMedCentralGoogle Scholar
- 13.Lloyd-Jones M, Hong JY, Labarthe FD, Mozaffarian KD, Appel CL, Linda VHM, et al. Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation. 2010;121(4):586–613.PubMedCrossRefPubMedCentralGoogle Scholar
- 15.World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep. 2000;894:i.Google Scholar
- 17.World Health Organization. The world health report 2002: reducing risks, promoting healthy life. Geneva: World Health Organization; 2002.Google Scholar
- 25.National Center for Health Statistics. Survey Description, National Health Interview Survey, 2018. Hyattsville, Maryland. 2019.Google Scholar
- 27.Mandrup CM, Egelund J, Nyberg M, Lundberg Slingsby MH, Andersen CB, Løgstrup S, et al. Effects of high-intensity training on cardiovascular risk factors in premenopausal and postmenopausal women. Obstet Gynecol. 2017;216(4):384.e1–384.e11.Google Scholar
- 34.Yang L, Wang Z. Abstract 16460: differential impact of cigarette smoking on prognosis in women compared with men with coronary artery disease undergoing percutaneous coronary intervention. Circulation. 2016;134:A16460.Google Scholar
- 36.Shivappa N, Hébert J, Kivimaki M, Akbaraly TN. Alternate healthy eating index 2010, dietary inflammatory index and risk of mortality: results from the Whitehall II cohort study and meta-analysis of previous dietary inflammatory index and mortality studies. Br J Nutr. 2017;118(3):210–21.PubMedCrossRefPubMedCentralGoogle Scholar
- 38.Nazare J, Smith J, Borel A, Aschner P, Barter P, Van Gaal L, et al. Usefulness of measuring both body mass index and waist circumference for the estimation of visceral adiposity and related cardiometabolic risk profile (from the INSPIRE ME IAA study). Am J Cardiol. 2015;115(3):307–15.PubMedCrossRefPubMedCentralGoogle Scholar
- 39.U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at https://health.gov/dietaryguidelines/2015/guidelines/. Accessed 24 June 2019.
- 45.Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015-2016. NCHS data brief 2017; no. 289.Google Scholar
- 50.Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. J Am Coll Cardiol. 2018;71(19):e127–248.PubMedPubMedCentralCrossRefGoogle Scholar
- 51.Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services; 2017.Google Scholar
- 52.American Diabetes Association. 9. Cardiovascular disease and risk management: standards of medical care in diabetes-2018. Diabetes Care 41:S86–S104.Google Scholar