Women’s cardiovascular disease outcomes are falling short of their highest potential—and improvement starts with an understanding of social drivers
The work to improve women’s heart health is becoming increasingly complicated, especially for underserved populations. But with increased awareness, clinicians can play a central role in improving outcomes for half the population. With the right support, practitioners can influence multiple gendered but addressable challenges across the healthcare landscape.
- Between 1995 and 2014, as acute myocardial infarction hospitalization rates for men under 55 dropped, the numbers for women of that same age group increased.
- Women are almost twice as likely as men to be misdiagnosed after a heart attack and are 30% more likely to have symptoms of stroke diagnosed incorrectly in the emergency department.
- Epidemiologic studies suggest that women and Black patients are less likely to receive a defibrillator when indicated compared to White males.
- The effects of heart disease on women weren’t investigated until the 1980s, and women weren’t included in National Institutes of Health (NIH)-funded research until the 1990s.
Public health campaigns have helped improve awareness that heart disease doesn’t just affect men, with awareness doubling between 1997 and 2009. But this progress is eroding. The loss is an opportunity for healthcare leaders to empower both clinicians and women in changing the trend and realizing even greater advancements in women’s heart health.
Awareness of women’s heart health issues is lagging
Boosting awareness of cardiovascular disease (CVD) risk is key to improving outcomes for patient populations, but understanding nuances across certain demographic factors is paramount.
Women’s health outcomes were the focus of aggressive public health campaigns in the United States in the 2000s and 2010s.
- 2002 - the National Institute of Health (NIH)-National Heart Lung Blood Institute (NHLBI) launched “The Heart Truth® Campaign.”
- 2004, 2007, 2011 - The American Heart Association (AHA) released three sets of evidence-based guidelines for cardiovascular disease.
The campaigns were generally successful. However, minorities saw lower levels of effectiveness, and, over time, there has been a significant loss of awareness of CVD as the leading cause of death in women. Awareness fell to 44% in 2019 from a peak of 65% in 2009.
Demographic risk factors for CVD in women vary
Younger women, in addition to Black and Latin women, drove the drop in awareness. Many still see CVD as a “man’s disease” or an older person’s issue. But these groups exhibit ample opportunity for improvement. Almost 75% of women between 20 and 39 have one or more modifiable risk factors for the disease, including:
- Hypertension
- Diabetes
- High cholesterol
- Smoking
- Being overweight or obese
The NHLBI has launched its “Yes, YOU!” program to increase CVD awareness among women in their 20s-40s, paying special attention to Black and Latin women—groups who have higher rates of diabetes, hypertension, and obesity.
Among Black women, 59% over the age of 20 have cardiovascular disease, but only 39% know that chest pain can be a sign of a heart attack. Only 33% are aware that pain that spreads to the arms, shoulder, or neck is another potential sign and a mere 20% of this CVD group has blood pressure under control, according to the AHA. Hispanic women face similar issues. Almost 78% are overweight or obese, 41.2% are prediabetic, and 43% have cardiovascular disease. This group develops heart disease an average of 10 years earlier than non-Hispanics.
Certain non-cardiovascular comorbidities can also add to the morbidity and mortality risk of heart failure—many of which are more common in Latin, Asian, and Native American women, including respiratory diseases, metabolic syndrome, and renal disease. Globally, the highest CVD mortality rates among women have been found in Central Asia, Eastern Europe, North Africa, and the Middle East.
