Cardiovascular Risk Factors Rife in Argentine Cardiologists

María Nayeli Ortega Villegas

February 17, 2023

Despite cardiologists' knowledge about cardiovascular disease and risk factors, they have a high prevalence of these risk factors. This observation suggests poor working conditions for cardiologists of both sexes and a high prevalence of workplace gender violence for female cardiologists, according to a study conducted by the Argentine Society of Cardiology (SAC) published in the Argentine Journal of Cardiology.

"The survey is rich and measurable in a population that is in captivity, and it reflects a reality of what living in it involves," said study author Bibiana Rubilar, MD, delegate of the Women's Area of the Argentine Society of Cardiology for the Interamerican Society of Cardiology.

According to the World Health Organization (WHO), cardiovascular diseases are the main cause of morbidity and mortality today. Most of these diseases can be prevented if traditional risk factors are controlled, such as tobacco and alcohol consumption, poor diet, and physical inactivity. Cardiology specialists therefore strive every day to control these factors in their patients and reduce the pathology.

However, health professionals are not exempt from suffering from risk factors. In the case of cardiologists, they do not always follow the recommendations they make to their patients.

With this background, the purpose of the paper was to detect the level of well-being, labor equity, and gender violence, as well as to know the prevalence of cardiovascular risk factors in Argentine cardiology specialists.

"This survey was not initially done to specifically look at gender violence in women," said Rubilar. "In the first instance, we had prepared it in terms of nontraditional risk factors that lead to cardiovascular disease, thinking about stress, and we asked the question to learn about gender violence for both sexes. Just as we proposed it, we saw that women had suffered it more and, belonging to that area, we questioned what this is about."

The study was observational, cross-sectional, and carried out through a survey in a digital, anonymous, and voluntary form. Surveys were distributed during September 2021.

Cardiologists' personal data, anthropometric measurements, traditional risk factors, and personal and family history of cardiovascular disease were obtained.

Information was collected on profession, years of specialty, population density of practice location, weekly workload, 12- or 24-hour medical shifts, and travel time to the workplace, as well as habits, health checks, and other nontraditional risk factors.

Participants were consulted about professional well-being, work, and domestic gender violence. Women were asked about their obstetric history, menopause, and professional growth based on maternity.

A total of 611 cardiology specialists participated, of whom 59.5% were men and 40.5% were women.

"One of the main challenges we faced was getting cardiology specialists to agree to take the time to participate in the survey, since in general health professionals, at least in our country, are overloaded with their schedules and do not usually think about their own cardiovascular health," said study author Verónica Crosa, MD, director of the Heart and Women area of the Argentine Society of Cardiology.

Sixty-three percent of those surveyed reported working more than 44 hours per week without differences due to sex. Female specialists predominated (38% vs 28%), however, among participants who worked 12- or 24-hour medical shifts.

"We saw that in order to not miss activities within their family, women group the hours," said Rubilar. "For example, instead of working a few hours 5 days a week, they worked two full days, 24 hours a day." She pointed out that sleep disturbance is a predisposing factor for cardiovascular disease.

There were also no differences by sex in the perception of well-being at work, where two out of three cardiologists considered that the workload was excessive. The same proportion thought that their remuneration was not commensurate with their academic training (75% of women compared with 60% of men).

According to the "Women as One" report, there is still a significant wage gap for medical staff. Women earn almost 30% less than men in some cases.

This perception of inequity operates as a chronic stress factor that qualifies as a risk factor for nontraditional cardiovascular disease.

Regarding the effect of the COVID-19 pandemic, 84% of those surveyed considered that it caused work and personal overload. This perception was also greater among women (88% vs 80%).

"This year, we suffered from the pandemic, which meant that women, for the simple fact of being a mother as well as a doctor and cardiologist, had to do housework and chores and in many cases be in charge of children, their education, and they were really overwhelmed because of the situation, and this was not something equitable, it cannot be said that the men suffered the same as women," said Rubilar.

Regarding other risk factors, men had more of a history of cardiovascular disease, being overweight, and obesity, with a higher median of triglycerides. Women were more sedentary, had a higher median cholesterol level, suffered more difficulty sleeping, and had more disinterest, negative thoughts, and unhappiness.

The workload reported by the specialists may explain the lack of adherence to healthy habits.

"We had the hypothesis that cardiology specialists did not comply with the same guidelines that we indicated to patients, which was confirmed. We are more sedentary, we adhere less to healthy guidelines, and we do not do periodic checkups," said Crosa.

Sixty-two percent of the cardiologists considered that motherhood limited their professional development, making visible the inequality that women face to fulfill their work, added to the assignment of family caregiver.

"There is a historical assignment of care roles to women in the family core, over the children, the husband, and parents, and this assignment makes it quite incompatible that we can also achieve a professional development comparable to that of men, because we have a burden of work at home and in the core of affections that men do not have," said Crosa.

Exposure to gender-based violence was significantly more common in women than in men at work (58% vs 10%) and at home (16% vs 10%).

"We were surprised by the high prevalence of gender violence in the workplace. We assumed that it was present, but the percentage of female cardiologists who made reference to having had a situation of gender violence is truly alarming," said Crosa.

This type of violence has serious consequences: it prevents women from fully participating in the space where they work. In addition, the emotional effects of this violence have been widely demonstrated to be a cardiovascular risk factor. It alters platelet reactivity and increases risk of coronary heart disease, as well as increasing the incidence of depression and suicide.

Rubilar and Crosa plan to investigate whether these patterns are repeated in other specialties. They envisage a political campaign to change conditions for female doctors, who are becoming more numerous.

"We had no knowledge of what was happening with professionals in Argentina, so this paper allows us to see a bit of what is happening. It was interesting to see a fairly even participation between men and women: 40% female and in the society register there are 30%, a little more representation than in the general register," said Lucía Kazelian, MD, head of the cardiology hospitalization unit of the Argerich Hospital in Buenos Aires and founding member of the Heart and Women Area of the Argentine Society of Cardiology. Kazelian is not among this paper's authors.

"The data on which they focused was not seen. Like most of the world, we still have a high percentage of male cardiologists over female cardiologists. And we see that the curve of women who have decided to dedicate themselves to cardiology is growing in a 5-year projection. If we look at the pattern of the Argentine Society of Cardiology, we find that men always predominate in the older age group. And if we project this, in a few years we will have an equal proportion between men and women," said Kazelian.

She agreed that the data obtained in the paper correspond to a starting point for strategies to improve working conditions in general. She highlighted the need to reform the approach to the maternity period, which, being historically associated with women's gender roles, delays female cardiologists' professional careers.

Eduardo Perna, MD, head of the Division of Heart Failure and Pulmonary Hypertension of the Corrientes Institute of Cardiology, in Corrientes, Argentina, who also did not participate in this paper, pointed out that the survey yielded valuable results on the inequity in the employment conditions of male and female cardiologists.

"The first message is to recognize the situation of the impact that gender has in the context of scientific societies, so we can make a diagnosis and, from there, implement behaviors to change what happens. The ratio of women to men in cardiology is increasing. In education, 70% of the students in the medical school are female, and even in the residences, half are made up of men and half are women, and this will surely change. It is a trend that deserves recognition, as long as we can implement something to change it," said Perna.

Due to this trend, it is necessary for a scientific society to analyze how equitable opportunities can be provided to women, he added. Dedication and individual characteristics, regardless of gender, should define professional advancement in the practice of cardiology and scientific research.

"Inequity is not only seen in the work area, but also in the scientific area. When we need an opinion article, an editorial, or a review, men are asked more than women. The fact of carrying out these analyses helps us to know where we should work and understand that this is not only applicable to Argentina, but that we must see it in all countries and take advantage of this information to be able to make cultural changes," Perna concluded.

This paper was awarded the Raúl Borracci Award at the 48th Argentine Congress of Cardiology. Rubilar, Crosa, Kazelian, and Perna report no relevant financial relationships.

Follow María Nayeli Ortega Villegas of Medscape's Spanish edition on LinkedIn.

This article was translated from Medscape's Spanish edition.


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