Women's Cardiovascular Health Research Articles

Association Between Severity of Depression and Cardiac Risk Factors Among Women Referred to a Cardiac Rehabilitation and Prevention Clinic.

Depression comorbid with cardiovascular disease is associated with higher rates of morbidity and mortality, with studies suggesting that this is especially true among women. This study examined depressive symptoms and their relationship to cardiac risk factors among women referred to a women's cardiac rehabilitation and primary prevention program. A secondary analysis of data collected between 2004 and 2014 for 1075 women who completed a baseline assessment at the Women's Cardiovascular Health Initiative, a women-only cardiac rehabilitation and prevention program in Toronto, Canada. Descriptive statistics for sociodemographic variables, quality of life (SF-36), and cardiac risk factors were stratified by depression symptom severity using cutoff scores from the Beck Depression Inventory-2nd version (BDI-II) and compared with analysis of variance and χ statistics. Prevalence of antidepressant use among those with moderate to high depressive symptoms was assessed as an indicator of under- or untreated depression. Overall, 38.6% of women scored above the BDI-II cutoff for depression; 23.6% in the moderate or severe range. Socioeconomic status and quality of life decreased with increasing depression severity. Body mass index increased with depressive severity (P < .001), as did the percentage of individuals with below target age predicted fitness (P < .001). Only 39.0% of women in the moderate and severe BDI-II groups were taking antidepressants. In this sample, we found a significant prevalence of untreated and undertreated depressive symptoms among women with, or at high risk of developing, cardiovascular disease. Additional strategies are needed to identify these patients early and link them to appropriate treatment.

Predictors of subclinical carotid atherosclerosis in middle-aged women

BackgroundTraditional strategies for primary cardiovascular prevention have been insufficient in reducing the high rates of coronary ischemic events in women, probably because these women are often stratified into low-risk groups. However, cardiovascular diseases continue to be the main cause of morbidity and mortality in women worldwide. We hypothesized that carotid atherosclerosis (CA) is common in middle-aged women.MethodsWe prospectively evaluated asymptomatic peri- and post-menopausal women with no cardiovascular diseases or the use of hormone therapy from two gynecologic clinics. All the patients underwent full clinical and laboratory evaluation and underwent a B-mode ultrasound for carotid evaluations. The presence of CA was defined as the presence of plaque and/or carotid intima-media thickness (CIMT)>1.00 mm. We performed logistic regression to evaluate independent predictors of CA.ResultsWe studied 823 women (age: 54.4±5.4 years; body mass index-BMI: 28.5±4.9 kg/m2; diabetes:10%; hypertension: 58%). The prevalence of CA was 12.7% for the entire population and 11% for the low-risk sub-group as defined by a Framingham risk score <5%. In the multivariate model, age: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25–1.89,p<0.001; current smoker status: OR = 2.69, 95% CI = 1.48–4.91, p = 0.001; total cholesterol: OR = 1.13, 95% CI = 1.03–1.24, p = 0.008; and systolic blood pressure: OR = 1.01, 95% CI = 1.00–1.02, p = 0.030 remained independently associated with CA.ConclusionSubclinical CA is common among asymptomatic middle-aged women, and traditional risk factors are independently associated with CA. These findings are particularly relevant for improving cardiovascular health in women.

Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach.

Although basic science and clinical research indicate that the vascular physiopathology of male and female sexual dysfunction (FSD) is similar, to date the association between FSD and cardiovascular (CV) diseases has been only marginally explored. To discuss the potential reasons for differences in the role of CV diseases and risk factors in sexual function in women vs men in the 2nd part of a 2-part review. A thorough literature search of peer-reviewed publications on the topic was performed using the PubMed database. We present a review of the main factors that could account for this gap: (i) actual physiologic discrepancies and (ii) factors related to the inadequacy of the methodologic approach used to investigate CV risk in patients with FSD. A summary of the available methods to assess female sexual response, focusing on genital vascularization, is reported. The microanatomy and biochemistry of the male and female peripheral arousal response are similar; in contrast, there are differences in the interplay between the metabolic profile and sex steroid milieu, in the relative weighting of cardiometabolic risk factors in the pathogenesis of CV disease, and their clinical presentation and management. CV diseases in women are under-recognized, leading to less aggressive treatment strategies and poorer outcomes. Moreover, evaluation of hemodynamic events that regulate the female sexual response has thus far been plagued by methodologic problems. To clarify whether sexuality can be a mirror for CV health in women, the female genital vascular district should be objectively assessed with standardized and validated methods. Studies designed to establish normative values and longitudinal intervention trials on the effect of the treatment of CV risk factors on FSD are urgently needed. Maseroli E, Scavello I, Vignozzi L. Cardiometabolic Risk and Female Sexuality-Part II. Understanding (and Overcoming) Gender Differences: The Key Role of an Adequate Methodological Approach. Sex Med Rev 2018;6:525-534.

Abstract P321: Family Member Incarceration and Subclinical Cardiovascular Disease in Mexican Women

Introduction: Losing a family member to incarceration is a stressful life event associated with emotional and financial burdens potentially influencing cardiovascular health through altered behavioral changes and psychobiological processes. Because of men′s higher likelihood of incarceration, women may disproportionately shoulder this burden. As the prison population increases globally, there is a need to evaluate the impact of incarceration on cardiovascular health in women. Hypothesis: Women who have or have ever had a family member in prison are more likely to have subclinical CVD compared to women without ever having an incarcerated family member. Methods: We examined the association between family member incarceration, carotid artery intima-media thickness (IMT), and subclinical CVD (sCVD) in 1,848 women reporting no CVD from the Mexican Teachers’ Cohort. Between 2013 and 2016, women responded to family incarceration related questions from the Life Stressor Checklist (LSC). We categorized women according to their response on whether they have or have ever had a family member incarcerated. IMT was measured on both carotid arteries through ultrasound by standardized neurologists and log transformed. We defined sCVD as an intima media thickness of ≥0.8mm in either of the carotid arteries or the presence of plaque. We collected data on potential cofounders (age, site, health insurance provider, indigenous background, education, marital status, socio-economic status, and LSC-measured exposure to violence) and potential intermediates (anthropometry, smoking, physical activity, hypertension, diabetes, and self-reported treated depression). We used multivariable linear and logistic regression models to assess the association between family incarceration, IMT, and subclinical CVD. Results: Among 275 (14.9%) women having experienced family incarceration, obesity (40.4% vs. 37.8%), smoking (8.7% vs. 6.5%), hypercholesterolemia (20.4% vs. 17.5%), and depression (7.3% vs. 4.7%) were more common relative to women without family incarceration. We did not observe an association between family incarceration and IMT when comparing exposed to unexposed women (confounder-adjusted mean % difference=0.48; 95%CI -01.15, 2.11). The prevalence of sCVD was 28.4% in women who ever experienced family incarceration and 20.9% in women with no family incarceration. The confounder-adjusted odds ratio for sCVD among women that have ever had an incarcerated family member was 1.40 (95%CI 1.03, 1.91) relative to women with no family incarceration. Conclusion: Having or having had an incarcerated family member was associated with increased sCVD in middle-aged Mexican women. Incarceration of a family member may exert a psychological burden that could disproportionally affect women’s cardiovascular health.

High Androgens in Postmenopausal Women and the Risk for Atherosclerosis and Cardiovascular Disease: The Rotterdam Study

Polycystic ovary syndrome (PCOS) is closely linked to hyperandrogenism (HA). In PCOS, HA has been associated with metabolic disturbances that increase the risk for cardiovascular disease (CVD). To assess the association of high serum androgen levels, as a postmenopausal remnant of PCOS, with the prevalence of atherosclerosis and incidence of CVD in postmenopausal women. The Rotterdam Study, a prospective population-based cohort study. Median follow-up was 11.36 years. General community. A total of 2578 women aged >55 years. Exclusion criteria were missing informed consent or follow-up data, perimenopausal status, and menopause by surgical intervention or at an unnatural age (age <40 or >62). None. Linear, logistic, and Cox regression models assessed the association of top quartiles (P75) of serum testosterone, free androgen index (FAI), dehydroepiandrosterone, and androstenedione and sex hormone-binding globulin with coronary artery calcium, carotid intima-media thickness (IMT), pulse wave velocity, peripheral artery disease, and incidence of coronary heart disease (CHD), stroke, and CVD. Mean age (standard deviation) was 70.19 (8.71) years, and average time since menopause was 19.85 (9.94) years. Highest quartile FAI was associated with higher pulse wave velocity (β [95% confidence interval (CI)], 0.009 [0.000 to 0.018]). Highest quartile dehydroepiandrosterone [β (95% CI), -0.008 (-0.015 to -0.001)] and androstenedione [β (95% CI), -0.010 (-0.017 to -0.003)] levels were associated with a lower IMT. We found no association between high androgen levels and incident stroke, CHD, or CVD. Postmenopausal high androgen levels were not associated with an elevated risk for CVD. Cardiovascular health in women with PCOS might be better than was anticipated.

Psychological Factors and Their Association with Ideal Cardiovascular Health Among Women and Men.

The cardiovascular effects of stress and other psychological factors may be different between women and men. We assessed whether self-perceived adverse psychological factors were associated with achievement of ideal cardiovascular health (CVH) as measured by the American Heart Association's Life's Simple Seven (LS7) and whether this differed by sex. This was a cross-sectional study of employees from a large healthcare organization. The LS7 metrics (smoking, physical activity, diet, body mass index, blood pressure, cholesterol, and glucose) were each scored as ideal (2), intermediate (1), or poor (0). Total scores were categorized as optimal (11-14), average (9-10), and inadequate (0-8). Using logistic regression, we tested whether psychological factors obtained by questionnaire (self-perceived stress, low life satisfaction, hopelessness, sadness, depression, and anxiety) were associated with CVH, after adjustment for age, ethnicity, and education. Among 9,056 participants, the mean (SD) age was 43 (12) years, 74% were women, 57% Hispanic/Latino, 17% white, and 16% black. Stress was associated with reduced odds of having optimal/average CVH [OR 0.58 (95% CI 0.50-0.66) and 0.63 (0.50-0.81), for women and men, respectively]. Similarly, depression was associated with reduced odds of optimal/average CVH [0.58 (0.43-0.78) and 0.44 (0.26-0.76), for women and men, respectively]. Low life satisfaction, hopelessness, sadness, and anxiety were also associated with statistically significantly lower odds of optimal/average CVH in women, but not in men; however, there were no interactions by sex. In an ethnically diverse population, both women and men with several adverse self-perceived psychological factors were less likely to have optimal or adequate CVH. Future studies are needed to determine whether addressing psychological stressors can improve CVH.

Estrogen-based hormone therapy in women with primary ovarian insufficiency: a systematic review.

Sex hormones play a role in bone density, cardiovascular health, and wellbeing throughout reproductive lifespan. Women with primary ovarian insufficiency (POI) have lower estrogen levels requiring hormone therapy (HT) to manage symptoms and to protect against adverse long-term health outcomes. Yet, the effectiveness of HT in preventing adverse outcomes has not been systematically assessed. We summarize the evidence regarding effects of HT on bone and cardiovascular health in women with POI. A comprehensive search of the electronic databases MEDLINE, EMBASE, and Scopus was conducted by a medical reference librarian from database inception to January 2016. Randomized trials and observational cohort studies with an estrogen-based HT intervention in women with POI under the age of 40 were included. Reviewers worked independently and in duplicate to assess eligibility and risk of bias, and extract data of interest from each study. The search identified 1670 articles; 12 met inclusion criteria. Four randomized clinical trials and eight cohort studies at high risk of bias enrolled 806 women with POI. The most common HT formulations were transdermal estradiol and oral conjugated equine estrogen combined with medroxyprogesterone acetate. Bone mineral density was the most frequent outcome, with three out of eight studies showing HT associated increase benefits. Only one study reported effects on fractures or vasomotor symptoms and none on cardiovascular mortality. Results regarding lipid profiles were inconsistent. Evidence supporting bone and cardiovascular benefits of HT in women with POI is limited by high risk of bias, reliance on surrogate outcomes, and heterogeneity of trials regarding the formulation, dose, route of administration, and regimen of HT. Further research addressing patient important outcomes such as fractures, stroke, and cardiovascular mortality are crucial to optimize benefits of this therapy.

Raising women's awareness of cardiovascular risks

Professor Claire Mounier-Vehier, a cardiologist and vascular specialist at Lille university regional hospital, is a leading spokesperson for women in the field of the prevention of cardiovascular diseases. One of her many roles is head of the 'heart, arteries and women health care pathway' set up in 2013 at Lille university hospital. She discusses the importance of this specific and multidisciplinary care pathway at a time when epidemiological data show that the management of women's cardiovascular health has become a public health priority.

Sex disparities in ideal cardiovascular health

ObjectiveTo quantify the gap in the distribution of ideal cardiovascular health (CVH) between men and women accounting for comorbidities, socioeconomic and psychological confounding factors.MethodsA cross-sectional analysis was conducted among 9012...

Advances in Cardiovascular Health in Women over the Past Decade: Guideline Recommendations for Practice.

Cardiovascular disease (CVD) remains the number one cause of death in women. It is estimated that 44 million women in the United States are either living with or at risk for heart disease. This article highlights the recent significant progress made in improving care, clinical decision-making, and policy implications for women with CVD. We provide our perspective supported by evidence-based advances in cardiovascular research and clinical care guidelines in seven areas: (1) primary CVD prevention and community heart care, (2) secondary prevention of CVD, (3) stroke, (4) heart failure and cardiomyopathies, (5) ischemia with nonobstructive coronary artery disease, (6) spontaneous coronary artery dissection, and (7) arrhythmias and device therapies. Advances in these fields have improved the lives of women living with and at risk for heart disease. With increase awareness, partnership with national organizations, sex-specific research, and changes in policy, the morbidity and mortality of CVD in women can be further reduced.

Effects of different durations of aerobic exercise on the cardiovascular health in untrained women: a meta-analysis and meta-regression.

Women's cardiovascular health is a hot topic. Exercise intervention is an effective method to improve the cardiovascular functions. The aim of this study was to systematically assess effects of aerobic exercise at different durations on the cardiovascular health of untrained women. Published articles from January 1989 to March 2016 were identified using electronic databases (PubMed, Cochrane Library, Embase and Web of Science) for randomized controlled trials. Weighted mean differences and 95% confidence intervals (CI) were calculated using fixed-effects and random-effects models. Meta-regression and subgroup analysis were performed to explore the possible heterogeneity. Data from 26 published studies with a total of 518 untrained women were identified. The subgroup analysis and meta-regression were performed according to age (under 40, and from 41 to 60 years old) and exercise durations. Maximal oxygen consumption significantly increased at short-duration exercise (95% CI: -2.51 to -1.57; I2=0%) and mid-duration exercise (95% CI: -8.23 to -5.18; I2=0%). While HR (95% CI: 4.72 to 5.60; I2=0%) and SBP (95% CI: 5.55 to 7.52; I2=0%) significantly decreased at mid-duration exercise. Total cholesterol (N.=242, 95% CI: 0.07 to 0.16, I2=13%), HDL-C (N.=242, 95% CI: -0.11 to -0.06, I2=11%) and low-density lipoprotein cholesterol levels (N.=238, 95% CI: 0.07 to 0.16, I2=37%) significantly improved with short-duration, mid-duration and long-duration. Improvement of cardiovascular functions decreases with age in untrained women. Short-duration exercise has significant effects on aerobic capacity. Mid-duration exercise significantly improves on aerobic capacity, heart rate and systolic blood pressure. All the different durations of aerobic exercise improve the cholesterol metabolism.

Vasomotor symptoms and women's cardiovascular health

Vasomotor symptoms and women's cardiovascular health

Cardiometabolic risk and female sexuality: focus on clitoral vascular resistance

Abstract Introduction The relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. Aim To investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. Methods Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Main Outcome Measures Patients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). Results Clitoral PI was positively correlated with body mass index (r = 0.441, P P P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause ( P P P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P P P P = .038 for positive symptom distress index; P Conclusion Clitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

PS-02-001 Cardiometabolic risk and female sexuality: Focus on clitoral vascular resistance

... The relationship between sexual and cardiovascular health in women is not well defined. Clitoral colour Doppler ultrasound (CDU) with assessment of pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. The aim of the present study was to investigate the associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters and self-perception of body image. Seventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Patients underwent a physical, laboratory and clitoral CDU examination, and completed the Female Sexual Function Index (FSFI), the Middlesex Hospital Questionnaire (MHQ) and the Body Uneasiness Test (BUT). Clitoral PI was positively correlated with body mass index (BMI) (r=0.441, p<0.0001), waist circumference (r=0.474, p<0.0001), glycaemia (r=0.300, p=0.029), insulin (r=0.628, p=0.002), HOMA index (r=0.605, p=0.005), triglycerides (r=0.340, p=0.011), total cholesterol (r=0.346, p=0.010) and LDL cholesterol (r=0.334, p=0.016). All the relationships, with the exception of glycaemia, retained statistical significance after adjusting for age, smoking habit and years of menopause (p<0.0001 for BMI, waist circumference and triglycerides; p<0.05 for all the other associations). At ANCOVA, after adjusting for confounders, women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (F=17.79, p=0.001; F=7.37, p=0.019, for obesity and MetS, respectively). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β=0.434; p=0.007). Clitoral PI was negatively associated with FSFI arousal (β=-0.321, p=0.014) and satisfaction scores (β=-0.289, p=0.026) and positively associated with somatized anxiety symptoms (MHQ-S), even after adjusting for age, smoking habit, years of menopause and current use of psychiatric medication (β=0.354, p=0.011). A positive association was also observed between PI and BUT Positive symptom distress index (PSDI) (β=0.322, p=0.039) and BUT-B dislike of womb, genitals and breast (β=0.538, p<0.0001; β=0.642, p<0.0001; β=0.549, p<0.0001, respectively). After introducing waist circumference as a further covariate, the associations between clitoral PI and BUT-PSDI, dislike of womb, genitals and breast retained statistical significance (p=0.038 for PSDI and p<0.0001 for the dislike of womb, genital and breast, respectively).

Cardiovascular health in women: The role of diet

The prevalence of cardiovascular diseases (CVDs) has been increasing over the years and is one of the leading causes of deaths in the Indian population. While women may have a lower risk of CVD, as compared to men, during the early phases of life, it has been determined that in the later stages of life, more number of women suffer from CVD as compared to men. Moreover, women might also experience disproportionately high mortality due to CVD. Obesity is among one of the most important reasons underlying greater burden of CVD in women. The problem of obesity is continuously growing even in developing countries like India and is more common in females and urban populations. Females are particularly prone to weight gain because of certain bodily changes which they have to go through during their life span. Obesity is associated with several risk factors such as type 2 diabetes, hypertension, dyslipidemia, which increase the risk of CVD. Additionally, obesity also leads to various other health problems such as uterine cancer, gallbladder disease, osteoarthritis, and breast cancer. Accordingly, prevention and management of obesity is an important health goal and diet plays an integral role in this. Diets rich in foods with high glycemic index (GI), high sodium content and low fruit and vegetable intake have been correlated with greater risk of CVD. Therefore, foods with low GI should be incorporated in the diets. In general, diets rich in dietary fiber have been associated with lower plasma cholesterol levels. Adequate intake of dietary fiber, phytochemicals, and antioxidants such as polyphenols, isothiocyanates, carotenoids, flavonoids, ascorbic acid and folates in the form of fresh fruits and vegetables offer cardioprotective benefits.

Cardiometabolic Risk and Female Sexuality: Focus on Clitoral Vascular Resistance

IntroductionThe relation between sexual and cardiovascular health in women is not well defined. Clitoral color Doppler ultrasound (CDU) with assessment of the pulsatility index (PI), reflecting resistance to blood flow, has been proposed as an objective measurement of sexual functioning. AimTo investigate associations between clitoral PI and cardiometabolic risk factors, sexual and intrapsychic parameters, and self-perception of body image. MethodsSeventy-one adult heterosexual women in a stable relationship attending our clinic for sexual dysfunction were consecutively recruited. Main Outcome MeasuresPatients underwent physical, laboratory, and clitoral color Doppler ultrasound examinations and completed the Female Sexual Function Index, the Middlesex Hospital Questionnaire, and the Body Uneasiness Test (BUT). ResultsClitoral PI was positively correlated with body mass index (r = 0.441, P < .0001), waist circumference (r = 0.474, P < .0001), glycemia (r = 0.300, P = .029), insulin (r = 0.628, P = .002), homeostatic model assessment index (r = 0.605, P = .005), triglycerides (r = 0.340, P = .011), total cholesterol (r = 0.346, P = .010), and low-density lipoprotein cholesterol (r = 0.334, P = .016). All relations, with the exception of glycemia, retained statistical significance after adjusting for age, smoking habit, and years since menopause (P < .0001 for body mass index, waist circumference, and triglycerides; P < .05 for all other associations). Analysis of covariance, after adjusting for confounders, showed that women with obesity or metabolic syndrome (MetS) showed significantly higher PI values (obesity: F = 17.79, P = .001; MetS: F = 7.37, P = .019). In particular, a stepwise increase of PI was found as a function of increasing MetS components (β = 0.434, P = .007). Clitoral PI was negatively associated with Female Sexual Function Index arousal (β = −0.321, P = .014) and satisfaction (β = −0.289, P = .026) scores and positively associated with Middlesex Hospital Questionnaire somatized anxiety symptoms, even after adjusting for age, smoking habit, years since menopause, and current use of psychiatric medication (β = 0.354, P = .011). A positive association also was observed between PI and the BUT positive symptom distress index (β = 0.322, P = .039) and BUT for dislike of the womb, genitals, and breast (β = 0.538, P < .0001; β = 0.642, P < .0001; β = 0.549, P < .0001, respectively). After introducing waist circumference as another covariate, the associations between clitoral PI and the BUT positive symptom distress index and BUT dislike of the womb, genitals, and breast retained statistical significance (P = .038 for positive symptom distress index; P < .0001 for dislike of womb, genitals, and breast). ConclusionClitoral vascular resistance is positively associated with MetS (in particular insulin resistance), decreased sexual arousal, body image concerns, and increased somatized anxiety symptoms. Further studies are needed to establish whether treatment of metabolic abnormalities might improve clitoral color Doppler ultrasound indices and sexual outcomes.

Electronic health record-based assessment of cardiovascular health: The stroke prevention in healthcare delivery environments (SPHERE) study.

< 3% of Americans have ideal cardiovascular health (CVH). The primary care encounter provides a setting in which to conduct patient-provider discussions of CVH. We implemented a CVH risk assessment, visualization, and decision-making tool that automatically populates with electronic health record (EHR) data during the encounter in order to encourage patient-centered CVH discussions among at-risk, yet under-treated, populations. We quantified five of the seven CVH behaviors and factors that were available in The Ohio State University Wexner Medical Center's EHR at baseline (May–July 2013) and compared values to those ascertained at one-year (May–July 2014) among intervention (n = 109) and control (n = 42) patients. The CVH of women in the intervention clinic improved relative to the metrics of body mass index (16% to 21% ideal) and diabetes (62% to 68% ideal), but not for smoking, total cholesterol, or blood pressure. Meanwhile, the CVH of women in the control clinic either held constant or worsened slightly as measured using those same metrics. Providers need easy-to-use tools at the point-of-care to help patients improve CVH. We demonstrated that the EHR could deliver such a tool using an existing American Heart Association framework, and we noted small improvements in CVH in our patient population. Future work is needed to assess how to best harness the potential of such tools in order to have the greatest impact on the CVH of a larger patient population.

Cardiovascular Disease in Women: Clinical Perspectives.

Cardiovascular disease continues to be the leading cause of death among women in the United States, accounting for ≈1 of every 3 female deaths. Sex-specific data focused on cardiovascular disease have been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex differences as they relate to clinical practice in the prevention, diagnosis, and treatment of cardiovascular disease. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including myocardial infarction associated with nonobstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other cardiovascular disease entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease, and abdominal aortic aneurysms, are also briefly reviewed. Finally, recommendations for cardiac rehabilitation are addressed.

Advancing Women's Heart Health through Policy and Science: Highlights from the First National Policy and Science Summit on Women's Cardiovascular Health

Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia Department of Cardiology, Hofstra North ShoreLIJ School of Medicine, Hempstead, New York WomenHeart: The National Coalition for Women with Heart Disease, Washington, District of Columbia Division of Cardiology, Emory University School of Medicine, Emory Heart and Vascular Center, Atlanta, Georgia Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota

Promoting Immigrant Women's Cardiovascular Health Redesigning Patient Education Interventions.

Cardiovascular disease is the most common cause of death among women from low- to middle-income countries. The most common cardiovascular nursing intervention is that of patient education. However, the applicability of this intervention is questionable, as these educational initiatives are typically designed and evaluated using samples of "white" homogeneous males. Using the social determinants of health framework, this discursive article identifies specific strategies for redesigning existing cardiovascular education interventions to enhance their applicability to immigrant women. The recommendations will allow nurses to enhance the educational support offered resulting in the reduction and/or prevention of cardiovascular-related symptoms and/or complications.