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UNDER-RECOGNISED FEMALE- SPECIFIC RISK FACTORS
• Early menopause
• Chronic inflammatory conditions
• Past pregnancy complications x2 ↑ CVD risk
UNDER-DIAGNOSED FEMALE- PREDOMINANT CONDITIONS
• More likely to have associated symptoms with MI chest pain
• More plaque erosion
• More small vessel disease
• More MI with nonobstructive coronary arteries ( MINOCA )
• Spontaneous coronary artery disease ( SCAD )
UNDER-TREATED
Women have delays in MI diagnosis
Women less likely to undergo invasive treatment or undertake secondary prevention
Traditional risk factors that increase CVD risk more in women than in men :
• Hypertension
• T2DM
• Smoking
MALE-PREDOMINANT CONDITIONS
• More focal obstructive large vessel disease
• More plaque rupture
• More fibrotic / calcified plaques
Women have poorer MI outcomes , with higher rates of death , than men
Figure 1 . Sex discrepancies in cardiovascular disease .
□ Routine CVD screening with AusCVDRisk
Sex-specific CVD risk assessment
• Early menopause
• Assessing pregnancy history
• Gestational diabetes
• Hypertensive disorders of pregnancy
• Preterm delivery
• Having small-for-gestational-age infant
• Autoimmune disorders
□ Reproductive health and CVD risk
HEART HEALTH CHECKLIST IN WOMEN
□ CVD risk monitoring in high-risk women
• Systolic and diastolic blood pressure
• HbA1c for type 2 diabetes
• Lipid profile
• Weight management
• Smoking cessation
• Physical activity
• Diet
□ Regular heart health checks
• Polycystic ovarian syndrome
• Previous pregnancy complications
• Menopause
• CVD risk screening in women with early menopause ( before 40 years of age )
• Lifestyle changes and CVD risk factor control during and after menopause
• For all women aged 45 years or older
• For First Nations women aged 30 years or older
• For women with diabetes aged 35 years or older
Risk factor control and lifestyle changes
Secondary prevention medications and cardiac rehabilitation
Figure 2 . Heart health screening and management in women for cardiovascular disease .
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assessment and to monitor CVD risk for women with past pregnancy-related complications . Additionally , the guideline recommends the recognition of the menopausal transition and perimenopause as a time to assess women ’ s CVD risk . Figure 2 outlines an approach to heart health screening and management of CVD in women .
Sex-specific guidelines are important . Research shows that women are less likely to receive cardiovascular screening , and that women and their healthcare
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providers tend to underestimate their risk for CVD . 14 , 29 This likely contributes to sex discrepancies in treatment and outcomes . These disparities are likely exacerbated in women of underserved ethnic groups and
14 , 29 of lower socioeconomic status .
Conclusion
There is still much to be done to close the sex gap in cardiovascular care . It is imperative to strive for equitable care by understanding sex-specific differences in risk
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factors , presentation and female-predominant cardiac conditions .
Conflict of interest declaration Professor Zaman has received research grants to her institution from Abbott Vascular and Biotronik Australia , and has received speaking / consulting honoraria from The Limbic , Novartis , Medtronic , Boehringer Ingelheim and AstraZeneca .
References on request from kate . kelso @ adg . com . au
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Online resources
• Australian CVD risk calculator bit . ly / 3PNh6Bb
• ACC Updated Recommendations for Primary Prevention of CVD in Women bit . ly / 3rtx1LF
• Heart Foundation of Australia : Women and heart disease bit . ly / 46m1dHC
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