Although cardiovascular disease is the number one killer of both men and women in the USA, more women die yearly—close to 500 000. Women are twice as likely as men to have heart failure, 1·5 times more likely to die within a year of a heart attack, and twice as likely to have a poor outcome after a coronary artery bypass graft. Furthermore, the cardiovascular mortality rate is rising in women younger than 55 years. Women often have non-chest-pain-specific cardiovascular symptoms. Two-thirds of women who die suddenly of coronary heart disease have no symptoms, probably reflecting a distinct microvasculature cause of cardiovascular disease in women.
Women’s cardiovascular risk factors are understudied. Psychosocial factors such as depression and stress are more common in women than men, and pregnancy-related complications (eg, gestational diabetes, hypertension, pre-eclampsia) significantly increase cardiovascular disease later in life. The exact nature of oestrogen’s protective effect on premenopausal cardiovascular risk remains unclear.
Guidelines for management of cardiovascular disease are primarily targeted at men because women are under-represented in clinical trials. Only a third of trials in cardiovascular disease publish sex-specific results even though US regulations require sex stratification. Although cardiovascular disease contributes 25% of total mortality and morbidity in the USA, relevant cardiovascular research receives only 4% of National Institute of Health funding.
Many American women are unaware of the risk posed by cardiovascular disease, which is an order of magnitude greater than that of breast cancer. Education and advocacy is needed across ethnic and socioeconomic strata to make women aware that the biggest threat to their health is their heart. Researchers must also redouble their efforts to study and improve outcomes for women at risk of cardiovascular disease.
Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.