Commission Outlines Plan for Global Fight Against CVD in Women

Megan Brooks

May 16, 2021

An expert panel convened by The Lancet calls for urgent action to reduce the global burden of cardiovascular disease (CVD) in women and has outlined an ambitious agenda to accomplish that goal.

The report, from the all-female-led Lancet Women and Cardiovascular Disease Commission, was presented May 16 during a plenary session at the American College of Cardiology (ACC) 2021 Scientific Session and simultaneously published online in The Lancet.

Stalled Progress

CVD is the number 1 cause of death in women around the world. An estimated 275.2 million women are diagnosed with heart disease worldwide, including 20.8 million in the United States, and most of these cases are preventable, the authors write.

Decades of grassroots campaigns have raised awareness about the impact of CVD in women, and positive changes affecting women and their health have gained momentum. Nonetheless, the past decade has seen "stagnation" in the overall reduction of CVD burden in women, the panel notes. CVD in women remains under-studied, -recognized, -diagnosed, and -treated. 

"For the first time ever, we are trying to gain a comprehensive understanding of what it may take to reduce heart disease among women worldwide. This problem has persisted unchanged for decades, and this commission is a critical step toward finding solutions," Roxana Mehran, MD, who led the effort, said in a news release.

Dr Roxana Mehran

"For example, physicians are aware that hypertension, smoking, hyperlipidemia, and diabetes are the most important evidence-based risk factors for heart disease. We now need to direct our study toward lesser-known risk factors that impact women's health," said Mehran, director, Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai in New York City.

These include the "pronounced but understudied role" of stress, psychosocial, and economic deprivation, as well as sex-specific CVD risk factors, such as preterm delivery, pre-eclampsia, premature menopause, and domestic violence, Mehran said.

"The commission concludes that by studying these types of factors, we can better prevent, identify, and treat heart disease, reducing mortality rates and improving women's health on a global scale," Mehran said.

Key Messages and Recommendations

1. Accurate data on global prevalence and outcomes of CVD in women are absent.

Recommendation: Direct funding for real-time and accurate data collection on prevalence and outcomes of CVD in women globally.

2. Women with CVD remain under-studied, -recognized, -diagnosed, and -treated.

Recommendation: Develop educational programs on CVD in women for physicians, scientists, allied health care professionals, and communities.

3. Sex-specific mechanisms in the pathophysiology and natural history of CVD remain poorly understood.

Recommendation: Prioritize sex-specific research focused on identifying the pathophysiology and natural history of CVD.

4. Women are under-represented in the majority of CV clinical trials.

Recommendation: Develop strategies to improve enrollment and retention of women in CV clinical trials.

5. Socioeconomic deprivation contributes substantially to the global burden of CVD in women.

Recommendation: Prioritize funding in global health organizations for CVD health programs in women from socioeconomically deprived regions.

6. Myocardial infarction and CVD mortality are increasing in young women.

Recommendation: Educate healthcare professionals and patients regarding early detection and prevention of CVD in young women.

7. Hypertension, dyslipidemia, and diabetes are the most crucial risk factors contributing to CVD death in women.

Recommendation: Establish policy-based initiatives and medical and community-outreach CVD risk factor programs in settings frequented by women.

8. Sex-specific and other under-recognized CVD risk factors, such as psychosocial and socioeconomic factors, appear to contribute to the global burden of CVD in women.

Recommendation: Research is needed to identify the effect of sex-specific, psychosocial, and socioeconomic risk factors on CVD in women and to evaluate intervention strategies.

9. Age-adjusted prevalence of CVD in women is increasing in some of the most populous countries of the world.

Recommendation: Scale up healthy heart programs in highly populated and progressively industrialized regions.

10. There is no current established global policy to coordinate prevention and treatment of CVD in women.

Recommendation: Embrace public–private partnerships to develop broad-scale programs to save lives in women with cardiovascular disease.

"These recommendations are a roadmap for combating this number 1 killer of women around the world," Mehran said.

"It is an undertaking of massive scale and scope and will require total commitment from governments, health organizations, technology sectors, and funding agencies to prioritize this urgent need for change. It is our hope that this roadmap will be the north star for the future of women's heart health," she added.

"Establishing these recommendations is an important step, but it's even more important how the 10 key messages are pragmatically implemented into concrete real-life settings," Valentin Fuster, MD, PhD, director, Mount Sinai Heart, and physician-in-chief, The Mount Sinai Hospital, said in the news release.

It's also important to develop "motivating heart disease prevention programs starting in early childhood and for women before and during pregnancy," Fuster said.

In a Lancet Comment, Ana Olga Mocumbi, MD, PhD, Mozambique National Institute of Health, who was not involved in the commission, says their recommendations calling for additional funding for women's CV health programs, prioritization of integrated care programs, including combined cardiac and obstetric care, and strengthening of the health systems, align with efforts to "bridge the gap for the world's worst off."

"Such a shift in women's cardiovascular care would be a major step towards equity, social justice, and sustainable development," Mocumbi writes.

The Lancet Women and Cardiovascular Disease Commission was supported financially by grants from Abbott Vascular, Abiomed, Amgen, AstraZeneca, Bristol Myers Squibb, CSL Behring, Janssen, Medtronic, Orbus Neich, Philips, and Sanofi, which had no role in study design, data collection, data analysis, data interpretation, or writing of the commission article. The funds were used towards the planning, development, and public launch of the commission article. None of the authors were paid for their work on the commission.

Lancet. Published May 16, 2021. Abstract, Comment

 American College of Cardiology (ACC) 2021 Scientific Session. Presented May 16, 2021.


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