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Chapter 1: HEART DISEASE IN WOMEN

Kavita Sharma; Martha Gulati

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INTRODUCTION

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Cardiovascular disease (CVD) is the leading cause of death in the United States (Figure 1-1).1 The burden of CVD is shared by men and women alike (Figures 1-2 and 1-3), although CVD's impact on women has been traditionally underappreciated. For far too long, women were not represented in major cardiovascular trials (Figure 1-4 and Table 1-1).2 In addition, both patients and physicians have displayed a lack of awareness regarding CVD's prevalence in women, although this scenario is changing now (Figure 1-5).3,4 The pathophysiology of CVD has unique characteristics in women. Furthermore, as women are increasingly being included in cardiovascular trials, management strategies specific to women are being defined.5,6,7,8,9 In this Atlas and Synopsis of Women's Cardiovascular Health, we hope to highlight the impact of CVD on women, its unique characteristics in women, and important topics in CVD that have female-specific management strategies.

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FIGURE 1-1

Cardiovascular disease (CVD) and other major causes of death: total, <85 years of age, and ≥85 years of age. Deaths among both sexes, United States, 2008, CLRD indicates chronic lower respiratory disease. Heart disease include International Classification of Diseases, 10th Revision codes I00-I09, I11, I13, I20-I51; stroke, I60-I69; all other CVD, I10, I12, I15, I70-I99; cancer, C00-C97; CLRD, J40-J47; Alzheimer disease, G30; and accidents, V01-X59, Y85-Y86. Reproduced with permission from Roger VL et al. Heart disease and stroke statistics—2012 update: a report from the American Heart Association. Circulation, 2012. 125(1): p. e2-e220.

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FIGURE 1-2

Demonstrates death rates by county for men ages 35 and over for heart disease. The burden of heart disease is particularly high in the South.

CDC, Behavioral risk factor surveillance system. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm. Accessed December 26, 2012.

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FIGURE 1-3

Demonstrates death rates by county for women ages 35 and over for heart disease with a preponderance in the South. http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_women_heart.htm. Accessed December 26, 2012.

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FIGURE 1-4

Enrolment of women in NHLBI-sponsored phase 3 to 4 cardiovascular randomized controlled trials from 1997 to 2006. Each trial is represented by a marker showing the type of cardiovascular disease process it studies (CHF indicates congestive heart failure; CAD, coronary artery disease; EPS, electrophysiological disease; HTN, hypertension). An asterisk by a trial name denotes that the subgroup analyses based on gender were published in the primary paper. The dotted line represents an arbitrarily chosen reference point of 50% enrollment, and the dashed line represents the average enrollment of women over 10 years, 27%.

Reproduced with permission from Kim ES, Carrigan TP, Menon V. Enrollment of women in National Heart, Lung, and Blood Institute-funded cardiovascular randomized controlled trials fails to meet current federal mandates for inclusion. J Am Coll Cardiol. 2008;52(8):673.

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