Editorial
Evaluating and Managing Cardiovascular Disease in Women
Understanding a Woman’s Heart
Alice K. Jacobs, MD; Robert H. Eckel, MD
D
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through the Go Red for Women campaign was an attempt to
address this need. In addition, although it has been recognized
that research that is directly relevant to women is insufficient,
this fact became even more apparent during the development
of these guidelines. As the 2001 Institute of Medicine report
Exploring the Biological Contributions to Human Health:
Does Sex Matter? noted,7 women have been underrepresented
in clinical research studies, although the major funders of
research in cardiovascular disease, the National Institutes of
Health and the AHA, have had guidelines in place since the
early 1990s to help improve this situation.
espite the efforts of investigators, public health and
private caregivers, voluntary health organizations,
and policymakers, heart disease continues to be the
leading cause of death in women, both in the United States
and throughout most of the world.1,2 A number of issues
contribute to these disappointing statistics.
Many women lack the basic awareness that cardiovascular
disease is the leading cause of death among women. The
American Heart Association’s (AHA) 2004 survey of
women’s attitudes and knowledge showed that, when asked
what they thought was the leading cause of death among
women, ⬎50% of women answered this question incorrectly.3 Even more important, only 13% of women personalized
this information and answered that their own personal greatest health threat was heart disease. Although this level has
increased from 7% since the initial survey 6 years ago, it is
still far too low. Furthermore, because coronary disease
becomes clinically evident in women about a decade later
than it does in men, women commonly believe that preventing heart disease can be postponed. They may believe that
they can begin to focus on it in their 50s, after other priorities
such as childbearing, child rearing, and caring for their
families no longer need their full attention. They miss the fact
so well demonstrated by the Pathobiological Determinants of
Atherosclerosis in Youth studies that atherosclerosis is often
evident in women in their 20s, that it is related to classical
cardiovascular risk factors, and that preventing it must start in
childhood.4,5 Publication of the AHA survey mentioned
earlier,3 as well as incorporation of the data in the efforts
toward increased public awareness of the AHA’s Go Red for
Women campaign, launched in 2004, served to highlight this
reality.
Healthcare professionals also may be unaware of women’s
risk for cardiovascular disease, and even if they are aware,
they may not have the information needed for the most
effective prevention and treatment. Publication of the first
evidence-based guidelines for cardiovascular disease prevention in women in February 20046 and distribution of toolkits
based on these guidelines to 80 000 physicians during 2004
Current Approaches to the Problem
In this issue of Circulation, the AHA continues its focus on
understanding a woman’s heart. We have included an important survey assessing physicians’ comfort levels with and
expertise in the prevention of heart disease in women.8 What
we learned suggests that educational efforts must be prioritized and they must begin early, be incorporated into medical
school curricula, and be continued while in clinical practice.
To help women who are aware of the risks and want to reduce
them, Manson and Johnson9 have contributed a Cardiology
Patient Page that women can copy or print out and show to
their healthcare professional. This page will help both patient
and clinician to assess the woman’s risk and decide the best
approach to cardiovascular disease prevention. We also have
included 2 new AHA Scientific Statements that will provide
healthcare professionals with the most up-to-date information
about noninvasive testing10 and interventional procedures11 in
women with coronary artery disease (CAD).
The statement on noninvasive testing10 addresses the lack
of recognition and diagnosis of CAD in women and the fact
that both have been implicated in women’s higher mortality
rates. Therefore, accurate diagnostic and prognostic testing
has the potential to improve outcomes. The higher prevalence
of nonobstructive CAD and single-vessel disease in women
as compared with age-matched men, which decreases the
diagnostic accuracy of conventional noninvasive testing,
coupled with the fewer number of women participating in
studies of these tests, limit the evidence base. However, the
writing group suggests that women with suspected CAD can
be accurately diagnosed and risk stratified with contemporary
cardiac imaging techniques and recommends that local expertise and availability guide the choice of test. Future studies
will be needed, however, to evaluate the importance of
traditional as well as emerging markers of risk, in addition to
the influence of hormonal, endothelial, and microvascular
function on the interpretation of noninvasive test results.
As in studies of noninvasive testing, women most often
represent less than one third of the population in studies
The opinions expressed in this article are not necessarily those of the
editors or of the American Heart Association.
From the Boston University School of Medicine, Boston, Mass
(A.K.J.), and the University of Colorado Health Sciences Center, Denver
(R.H.E.).
Correspondence to Dr Alice K. Jacobs, Department of Cardiology,
Boston Medical Center, 88 E Newton St, Boston, MA 02118. E-mail
[email protected]
(Circulation. 2005;111:383-384.)
© 2005 American Heart Association, Inc.
Circulation is available at http://www.circulationaha.org
DOI: 10.1161/01.CIR.0000155289.62829.0F
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Circulation
February 1, 2005
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evaluating treatment with percutaneous coronary intervention
(PCI). The statement on PCI in women11 is interesting in that
although women who undergo contemporary PCI are older
and have more comorbid disease and a higher prevalence of
risk factors as compared with men generally and with women
who previously underwent balloon angioplasty, outcomes in
women have improved and the gender difference in mortality
has decreased. Because women have a higher incidence of
bleeding and vascular complications, however, a careful
assessment of the risk– benefit ratio of an invasive strategy
must be undertaken, particularly because the benefit in
women with acute coronary syndromes may be limited to
high-risk women (ie, women with elevated troponin values).
It is clear that studies must mandate the increased recruitment
of women and include sex-specific results, particularly in
trials of new devices.
All of the studies and statements mentioned above are
based on a disturbing fact: Although women develop the
manifestations of coronary disease later than do men, inadequate prevention and the aging of the US population results in
the cardiovascular disease-related deaths of ⬎500 000 US
women every year. To be effective, prevention must begin
early. Thus, the AHA continues to aggressively address these
issues with its Go Red for Women campaign. The goal of the
campaign is to raise awareness among women and healthcare
professionals that cardiovascular disease is the greatest threat
to women’s health. This year, the campaign will create a
rallying cry for improved prevention and treatment of heart
disease in women. The campaign will be highly visible in the
media, both on television and in print, and numerous national
monuments will “go red” and many cities will mount “Go
Red” statues inspired by actors and actresses Melanie Griffith, Antonio Banderas, Geena Davis, Hector Elizondo, Jacklyn Zeman, Rita Moreno, James Woods, and Valerie Harper;
the cast of the daytime drama Passions; model Daisy Fuentes;
singer Toni Braxton; fashion designer Dana Buchman and
other designers featured at Macy’s; comedian Bill Cosby;
musician Dave Koz; former NBC Today anchor Jane Pauley;
celebrity chefs Rachael Ray and B. Smith; WNBA players
Lisa Lesley and Sheryl Swoops; and Univision’s Aqui y
Ahora coanchor Teresa Rodríguez. Critical additional elements of the initiative will provide help for the healthcare
professional. We hope that Go Red for Women will encour-
age women, working with healthcare professionals, to take
control of their heart health and live longer, stronger lives.
Watch for the campaign, and take its messages to heart.
References
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KEY WORDS: Editorials
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coronary disease
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prevention
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women
Evaluating and Managing Cardiovascular Disease in Women: Understanding a Woman's
Heart
Alice K. Jacobs and Robert H. Eckel
Downloaded from http://circ.ahajournals.org/ by guest on June 18, 2017
Circulation. 2005;111:383-384
doi: 10.1161/01.CIR.0000155289.62829.0F
Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231
Copyright © 2005 American Heart Association, Inc. All rights reserved.
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