ESC Congress 2021: Solutions for Gender-Based Gap in Cardiovascular Disease Diagnosis

Chairpersons Roxana Mehran, MD, and Barbara Casadei, FRCP, hosted “Global burden of cardiovascular disease in women; 20/20 vision for 2030: report of The Lancet Commission,” a panel discussion at European Society of Cardiology Congress 2021.

Stuart Spencer, senior executive editor at The Lancet, introduced The Lancet Commission on Cardiovascular Disease (CVD) in Women.

According to the commission, there are many factors that contribute to the inequity between men and women in the detection and management of CVD. The Lancet commission aimed to connect stakeholders, raise global awareness of these inequities and disparities, and encourage future research.

“The idea of a Lancet commission is to identify problem areas in important diseases and provide a roadmap for tackling the problems,” Spencer said in his presentation.

The authors wrote that women have been underrepresented in and excluded from cardiovascular clinical trials, and therefore reducing the chances of measuring multiple areas that could help prevent and manage CVD in women.

Overall awareness of this issue has increased in the past decade. However, most health care providers and patients still tend to underestimate the risk of CVD in women even though it is the leading cause of mortality in women and was responsible for 35% of all deaths of women in 2019.

Spencer also noted that, while women everywhere are affected, women in low-income and middle-income countries may have little access to risk-assessment opportunities, thus furthering the gap.

The role of women and women’s health in areas of poverty, malnutrition, and environment were identified as important areas for long-term research.

“There is still work to be done, and the commission identifies areas for further research,” Spencer said.

Gregory Roth, MD, MPH, is an adjunct associate professor at the Institute for Health Metrics and Evaluation (IHME) and an associate professor of medicine at the University of Washington School of Medicine. He presented data from the Global Burden of Disease (GBD) Study to discuss the global burden of CVD in women.

Roth also leads the cardiovascular research program within the GBD study, which estimates the burden of disease for 354 different diseases and injuries, and 84 risk factors across 204 countries. The study gives biannual updates using more than 30,000 data sources.

The findings showed how women are impacted by CVD geographically. Based on the 2019 sociodemographic index, life expectancy increased as the level of a country’s development increased.

At the same time, there were variations in life expectancy, CVD burden, and risk factors among women in countries at same level of development. There was also more variation in women compared with men in middle-income countries.

Women aged 75 and older were more likely to develop CVD and dementia than men, both of which increased the chance of death. More specifically, ischemic heart disease was the leading cause of CVD-related deaths in women, followed by interest cerebral hemorrhage, ischemic stroke, and hypertensive heart disease. For women aged 80 and older, high systolic blood pressure was the leading cause of death.

“I think it’s difficult to say one path forward,” chairperson Roxana Mehran said. “There are several paths forward on so many different directions, but we must act now.”

Jacqueline Saw, MD, professor of medicine at University of British Columbia and program director of international cardiology fellowship at Vancouver General Hospital presented 5 recommendations to reduce to global burden by 2030.

• Direct funding for real time and accurate data collection on prevalence and outcomes of CVD in women globally
• Develop educational programs on CVD in women for physicians, scientists, allied healthcare providers, and communities
• Prioritize sex-specific research on identifying the pathophysiology and natural history of CVD
• Develop strategies to improve enrollment and retention of women in cardiovascular trials
• Prioritize funding in global health organizations for CVD health programs in women from socioeconomically deprived regions

"Women are not small men. There are clear biological differences,” Saw said regarding sex-specific research and risk factors. “But the sex-specific pathophysiology of CVD in women is not well elucidated.”

Vijayalakshmi Kunadian, MD, MBBS, faculty of medical sciences at Newcastle University, presented 5 more recommendations.

• Educate healthcare providers and patients regarding early detection and prevention of CVD in young women
• Establish policy-based initiatives and medical and community outreach CVD risk factor programs in settings frequented by women
• Research is needed to identify the impact of sex-specific psychosocial and socioeconomical risk factors on CVD in women and evaluate intervention strategies
• Scale up healthy heart programs in highly populated and under-industrialized regions
• Embrace public-private partnerships to develop broad scale programs to save lives of women with CVD

“Well-known risk factors such as hypertension, cholesterol, and diabetes are very badly treated in women,” Kunadian said, noting these 3 factors are the most crucial risk factors contributing to CVD deaths in women. “And simple drugs are not being prescribed, and of course they end up with excess risk factors, as I have shown.”

Reference

Vogel B, Acevedo M, Appelman Y, et al. The Lancet Women and Cardiovascular Disease Commission: Reducing the Global Burden by 2030. Lancet. Published online May 16, 2021. doi:10.1016/S0140-6736(21)00684-X