Non-biological factors and social determinants are key in cardiovascular disease (CVD) risk assessment for women, particularly for women of diverse races, according to a new American Heart Association (AHA) scientific statement published today in Circulation.
“Risk assessment is the first step in preventing heart disease, yet there are many limitations to traditional risk factors and their ability to comprehensively estimate a woman’s risk for cardiovascular disease,” said Jennifer H. Mieres, MD, FAHA, vice chair of the scientific statement writing committee and a professor of cardiology at the Zucker School of Medicine at Hofstra Northwell in Hempstead, N.Y.
A 2022 American Heart Association presidential advisory declared that “Addressing the pervasive gaps in knowledge and care delivery to reduce sex-based disparities and achieve equity is fundamental to the American Heart Association’s commitment to advancing cardiovascular health for all by 2024.” This new scientific statement is a response to that.
Cardiovascular disease is the leading cause of death for all men and women. It is responsible for one in five female deaths in the U.S., according to the CDC.
Traditional formulas to determine cardiovascular disease risk include Type 2 diabetes, blood pressure, cholesterol, family history, smoking status, physical activity level, diet and weight. These authors note that this formula does not account for sex-specific biological influences on cardiovascular risk or medications and conditions that are more common among women than men.
They say female-specific factors that should be included in assessing cardiovascular risk are:
- Pregnancy-related conditions, such as preeclampsia, preterm delivery, gestational diabetes, gestational high blood pressure or miscarriage.
- Menstrual cycle history, such as age at first period and at menopause.
- Types of birth control and/or hormone replacement therapy used.
- History of chemotherapy or radiation therapy.
- Polycystic ovarian syndrome (PCOS), which affects up to 10% of women of reproductive age and is associated with higher risk for cardiovascular disease.
- Autoimmune disorders, which are twice as likely to occur in women and are associated with faster build-up of plaque in the arteries, higher risk of cardiovascular disease, and worse outcomes after heart attacks and strokes.
- Depression and post-traumatic stress disorder—both are more common among women and associated with a higher risk of developing CVD.
In addition, non-white women are more likely to face language barriers, discrimination, difficulties in acculturation or assimilation, lack of financial resources or health insurance, or lack of access to health care. Large patient data registries used to develop cardiovascular risk assessment formulas, the authors note, lack racial and ethnic diversity, so they may not accurately reflect risk for women of underrepresented groups
This statement highlights significant racial and ethnic differences in cardiovascular risk profiles for Non-Hispanic Black women, Hispanic/Latina women, American Indian and Alaska Native women, and Asian Americans.
“When customizing CVD prevention and treatment strategies to improve cardiovascular health for women, a one-size-fits-all approach is unlikely to be successful,” Mieres said. “We must be cognizant of the complex interplay of sex, race and ethnicity, as well as social determinants of health, and how they impact the risk of cardiovascular disease and adverse outcomes in order to avert future CVD morbidity and mortality.”