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 


This Halloween let’s discuss something genuinely frightening: Premature Death

Death is an inevitable part of the human experience. What’s truly terrifying is premature death, the abrupt cessation of life before one’s time, leading to disability, pain, human suffering, and the agonizing prolongation of dying.

The risk of experiencing premature death is deeply intertwined with the accessibility and availability of both beneficial and harmful products and services. Geography and economic factors play a significant role, often resulting in disparities that are both diverse and inherently unfair. Human behavior is remarkably malleable, influenced by the environment we inhabit. The availability of care and the presence of both advantageous and detrimental products further shape our fate.

Consider that the average life expectancy at birth in North America is approximately 74.5 years for men and 80.2 years for women. The median age at death, when we remove gender, geography, race, or ethnicity as dividers, stands at 73.7 years. The World Health Organization (WHO) designates death before the age of 70 as “premature.” So, let’s uncover the common culprits responsible for prematurely ending North Americans’ lives, and at what age they typically strike:

  1. Gunshot wounds: Median age at death, Striking at 28 years.
  2. Fentanyl: A devastating 35 years.
  3. Vehicular accidents: Crashing lives at 40 years.
  4. Overdose not otherwise specified (NOS): A chilling 46 years.
  5. Alcoholism: A sobering 57 years.
  6. Tobacco addiction: Snuffing out lives at a mere at 66 years.
  7. Cirrhosis: A grim 67 years.
  8. Diabetes: Cutting lives short at 67 years.
  9. Chronic kidney disease: Claiming victims at 68 years.
  10. Lung cancer: A tragic 71 years.
  11. Cancer NOS: A cruel end at 73 years.
  12. Stroke: Taking lives too early at 73 years.
  13. Myocardial infarction (heart attack): time stops ticking prematurely at 73 years.

All other significant causes of death, with median ages above 73.7, fall outside the “premature” category. These include Alzheimer’s disease, Parkinson’s disease, influenza, pneumonia, and sepsis.

Premature death, typically defined as occurring before the age of 70, is closely linked to factors like behavior control, addiction, and the presence of harmful agents. These agents encompass street drugs, alcohol, tobacco, unhealthy foods, and even firearms.

The accessibility of these harmful agents, including sugar-laden foods, ultra-processed junk, illicit drugs, and firearms, contributes to a wide array of health problems, from obesity and diabetes to addiction and violence. While society derives certain benefits from these substances and tools, it is imperative to weigh the risks they pose to our health.

Conversely, the availability of beneficial elements, such as quality education, gainful employment, safe living environments, and nourishing foods, can serve as a shield against premature death.

Addressing this alarming issue demands a multifaceted strategy, focusing on interventions that shape demand, harm reduction tactics, and the provision of support to encourage healthier choices. Despite the formidable challenges, it’s vital to strive for a society that prioritizes longevity and well-being.

Ultimately, it all boils down to choices—individual, family, societal, and governmental choices, whether wise or reckless. Life, along with its timing, is a calculable risk. So, why not choose a longer life and work towards making it better? Happy Halloween!


New Guidelines for streamlined lipid management approach focusing on cardiovascular disease prevention

These guidelines encompass both nonpharmacologic and pharmacologic interventions. Here’s a breakdown of the key recommendations:

  1. Physical Activity: The guidelines emphasize the importance of encouraging patients to engage in physical activity. Adherence to a regular exercise routine is considered more crucial than specifying a particular type, duration, or intensity of exercise.
  2. Mediterranean Diet: The Mediterranean diet is strongly recommended to reduce the risk of cardiovascular disease, highlighting the significant role of dietary choices in heart health.
  3. Primary Prevention with Statins: Healthcare professionals are advised to discuss the initiation of statins, preferably high-intensity statins, with patients who have a 10-year cardiovascular disease risk of 20% or higher for primary prevention.
  4. Primary Prevention with Statins (Moderate-Intensity): For patients with a 10-year cardiovascular disease risk falling in the 10%-19% range, clinicians are suggested to consider the initiation of statins, preferably of moderate intensity, for primary prevention.
  5. Lipid Level Re-testing: It is recommended to re-test lipid levels no earlier than five years and preferably in ten years for patients with a 10-year cardiovascular disease risk of less than 10% when estimating risk for primary prevention.
  6. Non-Statin Lipid-Lowering Drugs: The guidelines advise against the use of non-statin lipid-lowering medications either as monotherapy or in combination with statins for primary prevention.
  7. Secondary Prevention with High-Intensity Statins: For secondary prevention, healthcare providers are recommended to encourage the initiation of high-intensity statin therapy while discussing the potential risks and benefits with patients.
  8. Additional Risk Reduction: In cases where additional cardiovascular risk reduction is desired beyond maximizing statin therapy for secondary prevention, healthcare professionals are advised to discuss the potential use of ezetimibe or PCSK9 inhibitors with the patient.
  9. Icosapent Consideration: The guidelines suggest considering the addition of Icosapent to statins only after considering the potential adverse effects, such as atrial fibrillation and bleeding, following a discussion about the use of ezetimibe or PCSK9 inhibitors.

These updated guidelines provide a comprehensive framework for managing lipid levels and reducing the risk of cardiovascular disease, with a focus on tailoring interventions to individual patient risk profiles.



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 


Statin Intolerance

Many patients come to the pharmacy and tell me that they cannot tolerate Statins (Atorvastatin, Rosuvastatin, Simvastatin, etc.). I tell then that using Statins is extremely important to preventing heart disease, heart attacks, and premature death. Statins as a group of heart medications are responsible for preventing premature death in thousands upon thousands of individuals since 1987. 

Here are the latest guidelines for dealing with Statin Intolerance. The guidelines provide the following recommendations:

  1. Non-Severe Muscle Adverse Effects (most common): When patients experience non-severe muscle adverse effects with a specific statin regimen, the guidelines suggest the following:
    • Prefer the use of any statin intensity over non-statin lipid therapy.
    • This can involve continuing with the same statin, switching to a different statin, adjusting the statin dose, or considering alternate daily dosing. The choice should be made through shared decision-making between the patient and the healthcare provider.
  2. Primary Prevention in Patients Unable to Tolerate Statin (extremely rare): For patients who cannot tolerate any statin and are undergoing primary prevention, the guidelines recommend against the use of non-statin pharmacologic therapies. In this case, non-pharmacologic interventions and lifestyle modifications should be emphasized.
  3. Secondary Prevention in Patients Unable to Tolerate Statin(patients who have already had a previous heart attack): When patients are unable to tolerate any statin and are undergoing secondary prevention, the guidelines advise considering the following options:
    • A discussion about the use of ezetimibe, fibrates, or PCSK9 inhibitors. These can be explored as alternative pharmacologic therapies.
    • Icosapent should be considered only after other options have been thoroughly evaluated. It’s important to note that the use of icosapent should be approached cautiously due to its potential adverse events, such as atrial fibrillation and bleeding.

These guidelines aim to provide healthcare providers with a structured approach for managing patients who experience statin intolerance, ensuring that individualized decisions are made while considering the patient’s specific circumstances and risk factors.



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