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Researchers continue to investigate why sex differences in cardiovascular disease are important. Secha6271/Getty Images
  • Cardiovascular disease (CVD) claims the lives of 1 in 3 females around the world.
  • The incidence of CVD is lower in females than males, but females have a worse outlook and higher mortality rates.
  • Females are often underrepresented in clinical trials of CVD treatments.
  • The journal Circulation published its fourth “Go Red for Women” issue in 2020, covering a broad array of topics specifically devoted to CVD in women.

Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.

There is a widespread misperception that strokes and heart attacks are predominantly male health problems, but in reality, CVD is the leading cause of death among females worldwide, claiming the lives of 1 in 3, according to the American Heart Association (AHA).

According to the Centers for Disease Control and Prevention (CDC), heart disease accounted for 21.8% of all female deaths in the United States in 2017. Cancer, which was the second leading cause, accounted for 20.7% of deaths.

Research suggests that although the incidence of CVD in females is lower than in males, females tend to have a worse outlook and higher mortality rates after acute cardiovascular events. The authors note that these include coronary heart disease, stroke, heart failure, and aortic diseases.

In 2004, the AHA launched its Go Red for Women campaign to increase awareness of the sex differences in CVD, close any gaps in the standard of care between males and females, and educate the public about prevention.

In 2020, the AHA published a special issue devoted to the subject in their journal Circulation.

This was the journal’s fourth annual Go Red for Women issue.

In the editorial, the journal credits the campaign with increasing awareness, expanding research funding, and encouraging the publication of specific guidelines for the prevention and treatment of CVD in females.

The authors write that over the past 2 decades, and despite overall improvements, significant gaps in awareness persist, and adverse trends in disease incidence and treatment have emerged.

“Even one life lost is too many because we know much of heart disease and stroke is preventable and treatable,” says one of the editorial’s authors, Circulation Editor-in-Chief Dr. Joseph A. Hill, Ph.D.

Dr. Hill is chief of cardiology at UT Southwestern Medical Center and director of the Harry S. Moss Heart Center, both in Dallas, TX.

“Support for ongoing research, as well as female participation in pivotal clinical trials, are imperative to effectively address sex disparities in heart disease and stroke care as part of our effort to improve cardiovascular health for women,” he says.

“These are critical in our fight against heart disease and stroke in women.”

On the theme of participation in clinical trials, a study published in last year’s special issue reveals that between 2010 and 2017, out of 862,652 adults who took part in cardiovascular trials, only 38.2% were females.

This is an important deficiency because several studies in the special issue highlight the potential benefits of breaking down clinical data by sex rather than taking a “one-size-fits-all” approach to treatment.

One of last year’s articles reports that cardiologists and gynecologists are forming partnerships with the aim of identifying females at risk for CVD using sex-specific risk factors, including family and pregnancy history.

A relevant paper from 2013 provides a primer on unique female risk factors for CVD and preventive measures to take after identifying these factors.

Among these factors is body mass. A study in Sweden shows that increased body mass index (BMI) among young females is strongly associated with increased risk of cardiomyopathy, a condition that affects the heart muscle.

The researchers report that even mildly elevated body weight was associated with increased risk in young females.

Another study that featured in last year’s special issue highlights the challenges that remain for clinicians trying to redress the poorer cardiovascular outcomes among females compared with males.

The researchers found that among individuals who were resuscitated following a cardiac arrest in the community, 22.5% of females survived until discharge from hospital compared with 36.3% of males.

Females had a significantly lower discharge survival than males, especially among people whom doctors judged to have a better outlook after admission to the hospital.

However, in a statement earlier this month explaining the rationale for creating the journal’s annual Go Red for Women issue, Dr. Hill strikes an optimistic note:

“By publishing some of the best science on cardiovascular disease in women, our hope is that this issue of Circulation will catalyze the conduct of transformative and disruptive research in this area, enabling us to further our understanding of sex differences in CVD presentation and outcomes and effectively address sex disparities in cardiovascular care.”