The Heart of Cardiovascular Disease in Women

Abstract

Heart disease is the leading cause of death (LCOD) for both men and women in the United States and kills approximately 1 in every 4 women. 1 Tsao C.W. Aday A.W. Almarzooq Z.I. et al. on behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023; 147: e93-e621https://doi.org/10.1161/CIR.0000000000001123 Crossref PubMed Scopus (57) Google Scholar Despite widespread dissemination of staggering statistics, focused interventions, and national advocacy campaigns promoting cardiovascular disease (CVD) awareness, it is reported that only 45% to 56% of women identify CVD as the LCOD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar Also troubling is the downward trend of women identifying CVD as the LCOD as reported in the 2019 American Heart Association survey in which the percent dropped from 64.8% in 2009 to only 43.7% in 2019. 3 Cushman M. Shay C.M. Howard V.J. et al. Ten-year differences in women's awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey: a special report From the American Heart Association. Circulation. 2021; 143: e239-e248https://doi.org/10.1161/CIR.0000000000000907 Crossref PubMed Scopus (85) Google Scholar Previously excluded from clinical studies that inform best practice guidelines today, women continue to face historically rooted gender inequities resulting in suboptimal screening, inaccurate risk stratification, and a delay in diagnosis and management. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Women experience gender and sex-mediated risk factors for CVD and are disproportionally affected by traditional risk factors because of physiologic differences. 5 Cho L. Davis M. Elgendy I. et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review. J Am Coll Cardiol. 2020; 75: 2602-2618https://doi.org/10.1016/j.jacc.2020.03.060 Crossref PubMed Scopus (104) Google Scholar Although this is well-documented in the health care literature, nurse practitioners (NPs) and other clinicians report a lack of high-level confidence and comfort in screening women who may be at risk for CVD. 2 Bairey Merz C.N. Andersen H. Sprague E. et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women's Heart Alliance. J Am Coll Cardiol. 2017; 70: 1106-1107https://doi.org/10.1016/j.jacc.2017.07.721 Crossref Scopus (0) Google Scholar ,4 Shaw L.J. Pepine C.J. Xie J. et al. Quality and equitable health care gaps for women: attributions to sex differences in cardiovascular medicine. J Am Coll Cardiol. 2017; 70: 373-388https://doi.org/10.1016/j.jacc.2017.05.051 Crossref PubMed Scopus (69) Google Scholar Catherine Nadeau, DNP, APRN, FNP-BC, CNE, is an assistant professor and concentration director of the Family Nurse Practitioner Program at the University of South Florida in Tampa. Dr Nadeau can be reached at [email protected] Christina Cardy, DNP, APRN, AGACNP-BC, is an assistant professor and concentration director of the Adult Gerontology Acute Care Nurse Practitioner Program at the University of South Florida. Elizabeth Remo, DNP, APRN, FNP-BC, is an assistant professor at the University of South Florida. Anthony W. McGuire, PhD, ACNP-BC, ACNPC, FAHA, is an associate professor at the University of South Florida. Andrea Efre, DNP, APRN, ANP, FNP-C, is an assistant professor at the University of South Florida. Christina Bricker, PhD, APRN, FNP-BC, FAHA, is an associate professor at the University of South Florida.