Advancing Prevention: ASPC Establishes Women’s Cardiovascular Health Working Group
Cardiovascular disease (CVD) remains the leading cause of death among women, yet it is still frequently under-recognised and underdiagnosed. Despite growing awareness, significant gaps persist in how cardiovascular risk in women is assessed, studied and managed, particularly when it comes to sex-specific risk factors and differences in disease presentation.
To address these challenges, the American Society for Preventive Cardiology (ASPC) has established a Women’s Cardiovascular Health Working Group aimed at advancing prevention, research and clinical awareness.1 We spoke to co-Chair of the group and ASPC immediate past president Dr Martha Gulati (Director, Davis Women’s Heart Center; Professor of Cardiology; Davis Women’s Heart Endowed Chair; Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA) about the creation of the group, her thoughts on how clinicians and healthcare professionals can improve their work both in clinical practice and in research settings, and how we can close the gap in ongoing disparities in prevention, diagnosis, research and treatment of women with CVDs.
What clinical gaps or emerging evidence prompted the creation of the Women’s Cardiovascular Health Working Group within the American Society for Preventive Cardiology, and what are its primary aims for improving prevention strategies in women?
We created this working group to address the following:
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- under-recognition of CVD in women
- underrepresentation of women in CV research
- recognition of female-specific and sex-predominant risk factors
- persistent disparities in prevention, diagnosis, and outcomes in CVD and its risk factors in women.
As evidence specific to women and CVD prevention emerges, we want to provide ASPC members with the most up-to-date information to improve women’s cardiovascular health.
How should clinicians integrate sex-specific risk enhancers (such as adverse pregnancy outcomes, premature menopause and so on) into contemporary risk assessment models to better stratify cardiovascular risk in women?
Clinicians should integrate sex specific and female-predominant risk factors into cardiovascular risk assessment by incorporating them as risk-enhancing factors that modify traditional CVD risk estimates, prompting earlier screening, closer monitoring of CVD risk, and potentially earlier preventive therapy. Contemporary prevention strategies emphasize a lifespan approach for women, given that risk factors unique to women appear across all stages of a woman’s life.
In light of persistent disparities in diagnosis and treatment, what practical steps can healthcare systems take to reduce delays in recognising ischaemic heart disease and microvascular dysfunction in women?
Healthcare systems should move from a “rule out obstructive CAD” model to a “diagnose ischemia comprehensively” model. The 2021 ACC/AHA chest pain guideline emphasizes that women require evaluation for possible ischemia, and also that women are more likely to experience nonobstructive CAD with ischemia (INOCA).2 The chest pain guidelines provide an algorithm for evaluating ischemia, even in the absence of obstructive CAD, using coronary function testing or cardiac imaging tools. We need to continue the evaluation for symptomatic individuals even when an obstructive lesion is not found.
How is the working group addressing the underrepresentation of women in cardiovascular clinical trials, and what changes are needed to ensure that trial design and endpoints are more reflective of female-specific pathophysiology?
Our working group will advocate for promoting equitable enrolment of women into clinical trials, which should involve setting enrolment targets that mirror disease prevalence in women, improving recruitment pathways, reducing participation barriers, and encouraging trial sponsors and investigators to report results with a preplanned sex analysis built into trial design.
From a preventive cardiology standpoint, what evidence-based interventions across lifestyle, pharmacologic therapy and multidisciplinary care hold the greatest promise for closing outcome gaps in hypertension, lipid management and heart failure among women?
For me, the greatest promise related to lifestyle is the impact of exercise on CV health and mortality in women, where the effect seems more profound compared with men. Meaning women get more out of every minute of exercise or resistance training than men. The problem we need to address is enabling women to exercise throughout their lifespans. This means that, from childhood, a greater emphasis on activities people can do throughout life is more important than just focusing on team sports (not to minimize sports, but to think of exercise and activities as life skills).
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