Urgent action is required to reduce inequities in the heart health of women.

Investing in and enhancing research, knowledge, and equality in women's heart health are crucial for their health and well-being, according to a new Presidential Advisory from the American Heart Association, published today in the Association's flagship journal Circulation. The advise is a call to action to identify and eliminate obstacles to women's health care access, quality, and equality.

The guideline also emphasises the need for a cultural change in how cardiovascular health statistics are presented in order to achieve health parity for women. Roger said, "Comparing data from women to data from males naturally elevates data from men to the gold standard." "For instance, the assumption that women experiencing a heart attack are more likely to come with unusual symptoms implies that women present in the 'wrong manner'." The recommendation also proposes that data particular to women that does not characterise women's symptoms as "atypical" may lead to better diagnostic or treatment decisions, therefore promoting fair care.

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The advise presents an achievable road map separated into four major areas that need focus and investment to properly address women's heart health: 1) epidemiology and prevention; 2) awareness; 3) access to and delivery of equitable health care; and 4) engagement of health care providers, researchers, and communities.

"To minimise gender-based inequities and achieve equality, we must immediately address the widespread knowledge and health care delivery gaps. Improving cardiovascular health is impossible without achieving health equity "Adds co-author Nanette K. Wenger, M.D., FAHA, emeritus professor of medicine in the division of cardiology at Emory University School of Medicine, consultant to the Emory Heart and Vascular Center, founding consultant to the Emory Women's Heart Center, and director of the Cardiac Clinics and Ambulatory Electrocardiographic Laboratory at Grady Memorial Hospital in Atlanta.

Epidemiology and prevention

According to the January 2022 Heart Disease and Stroke Statistical Update, heart disease is the leading cause of death for men and women in the United States, and nearly half (44.4%) of adult women ages 20 and older had some form of cardiovascular disease, including high blood pressure, between 2015 and 2018.

The advise stresses that some risk factors for heart disease are unique to women or represent a different risk for CVD events in women than in males. These include:

Risks associated with the menstrual cycle: commencing early (younger than 11 years of age), early menopause (younger than 40 years of age), or hormone abnormalities that result in irregular ovulation (polycystic ovary syndrome) or unpredictable cycles.

Pregnancy and childbirth risks include hypertension or diabetes during pregnancy, preterm delivery, and having a baby with a birthweight below or above average.

Risks associated with the use of oral contraceptives and hormone replacement treatment.

Women are disproportionately afflicted by inflammatory and autoimmune diseases such as lupus, rheumatoid arthritis, and scleroderma. These disorders are linked to an increased risk of heart inflammation, heart and valve dysfunction, and heart attack.

Depression and anxiety are related with heart disease in women more commonly and at younger ages than in men.

Risks associated with the treatment of malignancies that are more frequent in women, such as breast, uterine, and ovarian cancer. Some therapies may be harmful to the heart; thus, heart health in women may need to be evaluated during and after therapy.

"We must assist women create a 'lifetime approach' to their health in which they are empowered to proactively control their heart disease risk at all stages of life," added Wenger.

Heart health is deteriorating among U.S. women who are contemplating pregnancy, and the heart health of pregnant women is suboptimal. These variables may result in pregnancy difficulties for the mother and future health risks or consequences for her and her children.

"We urge that cardiologists, general care doctors, and obstetricians and gynaecologists collaborate to measure and minimise cardiovascular disease risks throughout a woman's life. These multidisciplinary collaborations are essential for creating and executing the most effective strategies to promote the overall health of women "Wenger said.

Awareness

The awareness of heart disease as the primary cause of mortality among women increased from 30% to 56% between 2004 and 2009. In 2019, 44 percent of women identified heart disease as the major cause of mortality for women. Young women (ages 25-34) and those who identified as Black or Hispanic had the greatest declines in knowledge.

To offset these declining numbers, the advisory group proposes improving health care professional education. Nearly seven out of ten postgraduate medical students report inadequate or no instruction in gender-based medical concepts, and just 22 percent of doctors and 42 percent of cardiologists feel appropriately equipped to diagnose heart disease particular to women.

The American Heart Association has sponsored campaigns to raise women's heart health awareness for almost two decades, including the 2004 Go Red for Women campaign. Under the Go Red banner, the Association launched Research Goes Red in 2019 in partnership with Verily's Project Baseline. Research Goes Red is an online platform that intends to engage more women, particularly younger women and women of colour, in clinical research to better understand their symptoms, risks, diagnosis, and treatments.