Primary prevention of cardiovascular disease in women

Abstract

Ischemic heart disease is the primary cause of cardiovascular disease (CVD) mortality in both men and women. Strategies targeting traditional modifiable risk factors are essential – including hypertension, smoking, dyslipidemia and diabetes mellitus – particularly for atherosclerosis, but additionally for stroke, heart failure and some arrhythmias. However, challenges related to education, screening and equitable access to effective preventative therapies persist, and are particularly problematic for women around the globe and those from lower socioeconomic groups. The association of female-specific risk factors (e.g. premature menopause, gestational hypertension, small for gestational age births) with CVD provides a potential window for targeted prevention strategies. However, further evidence for specific effective screening and interventions is urgently required. In addition to population-level factors involved in increasing the risk of suffering a CVD event, efforts are leveraging the enormous potential of blood-based ‘omics’, improved imaging biomarkers and increasingly complex bioinformatic analytic approaches to strive toward more personalized early disease detection and personalized preventative therapies. These novel tactics may be particularly relevant for women in whom traditional risk factors perform poorly. Here we discuss established and emerging approaches for improving risk assessment, early disease detection and effective preventative strategies to reduce the mammoth burden of CVD in women.

摘要

缺血性心脏病是男女性心血管疾病(CVD)死亡的主要原因。针对经典可变风险因素的管理策略是必不可少的, 包括高血压、吸烟、血脂异常和糖尿病, 尤其是动脉粥样硬化, 但也包括中风、心力衰竭和某些心律失常。然而, 与教育、筛查和公平获得有效预防疗法有关的挑战依然存在, 这对全球女社会经济地位较低女性群体来说尤其困难。女性特有的风险因素（如早绝经、妊娠期高血压、小胎龄分娩）与心血管疾病的关联, 为有针对性的预防策略提供了潜在的窗口。然而, 迫切需要进一步的证据来证明具体有效的筛查和干预措施。除了增加心血管疾病风险的人群因素外, 人们正在努力利用基于血液的“组学”的巨大潜力, 改进成像生物标志物和日益复杂的生物信息学分析方法, 努力实现更个性化的早期疾病筛查和个性化的预防治疗。这些新颖的策略可能特别适用于没有明显传统风险因素表现的女性。本研究讨论了现有的和新兴的方法, 以改善风险评估, 早期疾病筛查和有效的预防策略, 以减轻女性在心血管疾病方面的巨大负担。

Keywords:

• Coronary artery disease
• prevention
• risk factors
• biomarkers
• precision medicine

Potential conflict of interest

R. Mehran reports equity <1% in Applied Therapeutics, Elixir Medical and STEL, and <1% (spouse) in ControlRad; and non-financial support from the American Medical Association (Scientific Advisory Board), Society for Cardiovascular Angiography & Interventions (Women in Innovations Committee Member) and Faculty CRF. G. A. Figtree reports non-financial support from CAD Frontiers Pty Ltd, Prokardia Pty Ltd and Australian Cardiovascular Alliance; and patents (planned, pending or issued) for ‘Use of P2X7R antagonists in cardiovascular disease’ [PCT/AU2018/050905], ‘Methods for predicting coronary artery disease’ [AU202209266] and ‘Novel P2X7 Receptor Antagonists’ [PCT/AU2022/051400]. M. P. Gray, B. Vogel and J. A. Leopold report no relevant financial conflicts of interest.

Source of funding

Nil.