It is a pleasure to write an introduction to these articles concerning cardiovascular disease in women and note the many advances in this field over the last decade. The increased awareness of the extent and impact of cardiovascular disease, along with advances in research and technology, has led to better prevention, management and care of women with cardiovascular disease.
Several of the advances are highlighted in this issue. Khairy et al. discuss the care of pregnant women with congenital heart disease, an area of increasing importance as more women with congenital heart disease are surviving to childbearing age. Indeed, currently there are half a million women of childbearing age with congenital heart disease in the USA, emphasizing the need for increased medical knowledge in this area. Registries in adult congenital heart disease are now collecting valuable data on this population, further enhancing our knowledge base for what used to be a rare condition in adults.
Monreal et al. discuss women’s risk for venous thromboembolism (VTE) while taking oral contraceptives. Although there have been advances in dosage, chemical composition and route of administration, the risk for VTE remains elevated while on hormonal contraceptives and it remains challenging to assess this risk.
Prevention remains the foundation of our strategies to reduce heart disease in women. Lifestyle measures, such as a heart-healthy diet rich in fruits and vegetables, regular physical activity and not smoking are extremely effective in reducing cardiac risk and preventing heart disease. Kuller discusses the role of risk factor reduction in prevention, while Turnbull focuses on the relationship between blood pressure, specific treatments and cardiovascular risk in men and women.
Our knowledge of sex-specific data is enhanced by increased enrollment of women in clinical trials and the sex-specific reporting of results. A recent study found that only 24% of all cardiovascular trials report sex-specific results Citation[1]. Yet the reporting of sex-specific results is essential in order to be sure that treatments are equally effective in women and men Citation[2]. There have been surprizing examples where data for new technologies have failed to show a benefit in women, although the treatments have been assumed to be effective in women on the basis of data in men. One such example is implantable cardioverter-defibrillators (ICDs) Citation[3]. A recent meta-analysis of all randomized trials of ICDs for primary prevention in women with heart failure found no benefit of ICDs compared with a conventional therapy in women Citation[4].
The Heart Disease Education, Analysis Research, and Treatment (HEART) for Women Act would dramatically improve the availability of sex-specific data. This legislation currently has 163 cosponsors in the House and 43 in the Senate Citation[101]. It is supported by the American Heart Association/American Stroke Association, among other groups. This important bill would amend the Federal Food, Drug and Cosmetic Act to allow the Secretary of Health and Human Services to deny a new drug application if the application fails to include required information on clinical investigations. This is crucial because some medications as well as devices behave differently in men and women. Passage of this legislation would help ensure that heart disease and stroke are more widely recognized and more effectively treated in women. The bill would also improve screening for low-income women at risk for heart disease and stroke. This legislation would authorize grants to educate healthcare professionals about the prevalence and unique aspects of care for women in the prevention and treatment of cardiovascular diseases.
Heart disease remains the number one killer of women and stroke is the number three killer of women. Heart attack, stroke and other cardiovascular diseases kill more women than the next five causes of death combined. Only continued awareness, education and research, such as highlighted in this issue, will help us to reduce the toll of cardiovascular disease in women.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
References
- Blauwet LA, Hayes SN, McManus D, Redberg RF, Walsh MN. Low rate of sex-specific result reporting in cardiovascular trials. Mayo Clin. Proc.82(2), 166–170 (2007).
- Hayes SN, Redberg RF. Dispelling the myths: calling for sex-specific reporting of trial results. Mayo Clin. Proc.83(5), 523–525 (2008).
- Redberg RF. Is what is good for the gander really good for the goose? Arch. Intern. Med.169(16), 1460–1461 (2009).
- Ghanbari H, Dalloul G, Hasan R et al. Effectiveness of implantable cardioverter-defibrillators for the primary prevention of sudden cardiac death in women with advanced heart failure: a meta-analysis of randomized controlled trials. Arch. Intern. Med.169(16), 1500–1506 (2009).
Website
- The Library of Congress: Thomas. www.thomas.gov