Call to Action for Cardiovascular Disease in Women: Epidemiology, Awareness, Access, and Delivery of Equitable Health Care: A Presidential Advisory From the American Heart Association

Abstract

Addressing the pervasive gaps in knowledge and care delivery to reduce sex-based disparities and achieve equity is fundamental to the American Heart Association’s commitment to advancing cardiovascular health for all by 2024. This presidential advisory serves as a call to action for the American Heart Association and other stakeholders around the globe to identify and remove barriers to health care access and quality for women. A concise and current summary of existing data across the areas of risk and prevention, access and delivery of equitable care, and awareness and education provides a framework to consider knowledge gaps and research needs critical toward achieving significant progress for the health and well-being of all women.

Cardiometabolic Risk and Cardiovascular Disease in Young Women With Uterine Fibroids

“…Heart disease is a leading cause of mortality in women [1][2][3]. An estimated 275 million women worldwide have cardiovascular disease (CVD), and heart disease accounted for 35% of all deaths in women in 2019 [1][2][3]. General risk factors for CVD include lifestyle, hypertension, obesity, and diabetes [1][2][3].…”

“…An estimated 275 million women worldwide have cardiovascular disease (CVD), and heart disease accounted for 35% of all deaths in women in 2019 [1][2][3]. General risk factors for CVD include lifestyle, hypertension, obesity, and diabetes [1][2][3]. Female-specific factors related to pregnancy, such as gestational hypertension and diabetes, are known to increase cardiovascular risk in later life [1,2,4].…”

“…General risk factors for CVD include lifestyle, hypertension, obesity, and diabetes [1][2][3]. Female-specific factors related to pregnancy, such as gestational hypertension and diabetes, are known to increase cardiovascular risk in later life [1,2,4]. Other non-pregnancy conditions in women also have been linked to cardiovascular risks, such as the presence of uterine fibroids, which is associated with increased blood pressure and other cardiovascular risk factors [5][6][7][8].…”

“…Some studies report an increase in cardiovascular risk and coronary heart disease after hysterectomy, but these analyses included patients with a diversity of uterine disorders, many of whom also underwent oophorectomy, which might have affected cardiovascular endpoints [10][11][12]. Nevertheless, an important component of CVD prevention is the acknowledgement of female-specific risk factors across the life course that may warrant specialized approaches to risk assessment [1,2,[4][5][6][7]. These risk factors include combined oestrogen-progesterone hormonal contraceptives, hypertensive disorders of pregnancy, preterm delivery, menopause, and menopausal hormone therapy [1,2,4], but the cardiovascular impact of fibroids is underrecognized and often not noted in papers or guidelines on women-specific management of cardiovascular risk [1,2,4].…”

“…Nevertheless, an important component of CVD prevention is the acknowledgement of female-specific risk factors across the life course that may warrant specialized approaches to risk assessment [1,2,[4][5][6][7]. These risk factors include combined oestrogen-progesterone hormonal contraceptives, hypertensive disorders of pregnancy, preterm delivery, menopause, and menopausal hormone therapy [1,2,4], but the cardiovascular impact of fibroids is underrecognized and often not noted in papers or guidelines on women-specific management of cardiovascular risk [1,2,4]. Therefore, we assessed whether there is an independent association between uterine fibroids and cardiovascular events in a cross-sectional population setting.…”