Improving the Cardiovascular Health of Women in the Nation: Moving Beyond the Bikini Boundaries

Abstract

espite recent declines in cardiovascular mortality in women over the past decade, cardiovascular disease (CVD) remains the number 1 killer of women. 1 Deaths attributable to CVD outnumber the deaths attributable to breast, ovarian, uterine, cervical, or vaginal cancers, or childbirth combined, and yet, when the medical community refers to women's health, they continue to focus on the bikini boundaries. SEX DIFFERENCES IN TREATMENT FOR CVDWomen continue to be labeled as a special population in many guidelines relating to CVD, despite being the majority of the population.Nonetheless, when presenting with an acute coronary syndrome, it is women, in particular, younger women, who are less likely to receive guideline-recommended therapies, timeliness of care, or diagnostic and invasive therapies resulting in worse outcomes in comparison with men. 2 Women who experience cardiac arrest are less likely to receive bystander CPR than men, and less likely to receive guideline-recommended therapies.The prevalence of heart failure is greater in women than in men, and, despite the sex differences in the causes and types of heart failure, women with heart failure with reduced ejection fraction are less likely to receive evidence-based therapies, including medications, implantable cardioverter defibrillators, ventricular assist devices, and heart transplant, despite improved survival and quality of life when receiving these therapies.Asymptomatic peripheral artery disease is twice as common in women as in men, and once a diagnosis of peripheral artery disease is made, women have greater functional impairment, lower rates of revascularization, and an increased likelihood of emergent procedures.This persistent pattern of poorer cardiovascular outcomes appears predominantly attributable to suboptimal use of guideline-recommended therapy in women, despite the strong evidence that management of CVD with evidence-based therapies benefits both sexes equally. Improving the Cardiovascular Health of Women in the NationMoving Beyond the Bikini Boundaries