Cardiovascular Disease Research in Women: Underrepresented and Underdiagnosed

Cardiovascular disease (CVD) stands as the primary global cause of death, accounting for approximately 17.9 million fatalities in 2019. In Canada, it ranks as the second leading cause of death for both men and women, with heart disease and stroke emerging as the top culprits for premature female mortality. Notably, the manifestation of heart disease differs between genders; women commonly exhibit microvascular disease in smaller vessels, while men tend to experience macrovascular disease in larger vessels. Consequently, the symptoms presented by women may vary from those observed in men. Hormone-related changes, specific medical conditions, and medications unique to women can also influence CVD development. Unfortunately, research studies have not consistently included women, resulting in unequal representation and potentially disparate treatments upon diagnosis. Addressing this gap requires further studies and enhanced educational efforts tailored to women, recognizing their distinct experiences with CVD, characterized by smaller vessel involvement and specific risk factors. Here is a breakdown:

Differences in Presentation:

  1. Acute Coronary Syndrome (ACS):
    • Women present at an older age than men.
    • Atypical symptoms such as fatigue, shortness of breath, and palpitations are more common.
    • Higher risk of heart failure and cardiogenic shock post-STEMI.
    • Less likely to receive reperfusion therapy or attend cardiac rehabilitation.
  2. Heart Failure (HF):
    • Hypertension and diabetes pose higher risks for women.
    • HF with preserved ejection fraction (HFpEF) is more common.
    • Underrepresented in HF trials; may benefit more from certain medications.
    • Less likely to receive device therapy (ICD or CRT) compared to men.
  3. Atrial Fibrillation (AF):
    • Greater risk of AF-related stroke than men.
    • Higher morbidity and mortality associated with AF.
    • Less likely to receive catheter ablation or optimal anticoagulation.
  4. Hypertension:
    • Prevalence increases after menopause.
    • Undertreatment of hypertension in women suggested.
  5. Dyslipidemia:
    • Elevated cholesterol increases MI risk.
    • Statin use may be lower in women post-MI.
  6. Diabetes:
    • Higher risk of coronary heart disease and adverse outcomes post-STEMI.
    • Underdiagnosed and undertreated in women.
  7. Stroke:
    • Higher lifetime risk in women.
    • Delayed diagnosis and suboptimal treatment for women.

Conditions and Risk Factors More Prevalent in Women:

  1. Spontaneous Coronary Artery Dissection (SCAD):
    • Mainly affects women, especially during pregnancy.
    • High risk of recurrent CV events.
  2. Takotsubo Syndrome:
    • Affects women more often, linked to emotional or physical stress.
  3. Polycystic Ovarian Syndrome (PCOS):
    • Increases the risk of metabolic syndrome.
  4. Pregnancy/Menarche:
    • Adverse pregnancy outcomes increase CVD risk.
    • Menopause, especially premature, elevates CVD risk.
  5. Influence of Medications:
    • Estrogen–progestin contraceptives increase thrombosis risk.
    • Hormone replacement therapy impact is inconclusive.
  6. Autoimmune and Inflammatory Diseases:
    • Women with autoimmune diseases face increased CVD risk.

Improving awareness and care for CVD in women is crucial, and pharmacists can play a pivotal role in this endeavour. Pharmacists possess the expertise to educate patients, enhancing their understanding of cardiovascular disease (CVD) risk factors, as well as the signs and symptoms of the condition, especially in women. Their role extends to educating on non-drug interventions, encompassing aspects like increased physical activity, maintaining a healthy diet, ensuring adequate sleep, stress reduction, and avoiding smoking—all of which contribute to lowering CVD risk. In the management of CVD risk factors such as diabetes and hypertension, pharmacists play a crucial role in assisting patients in achieving optimal blood glucose/A1C and blood pressure targets. Beyond that, they contribute significantly to the management of heart failure (HF), reducing HF hospitalizations when part of a multidisciplinary HF team. Numerous studies highlight the positive impact of pharmacist involvement in areas like diabetes, hypertension, smoking cessation, adherence in coronary heart disease (CHD) and HF, and cardiovascular mortality in HF. 

Please speak to your pharmacist at Centrum Pharmacy to gain a better understanding of women’s heart disease and how your lifestyle and medications play a role in your health. 



The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your health care provider first. Full Disclaimer 

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