Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Current Cardiology Reports
Published in: Current Cardiology Reports 8/2022

14-06-2022 | Coronary Heart Disease | Women and Cardiovascular Health (N Goldberg and S Lewis, Section Editors)

Prevention of Coronary Artery Disease in Women

Authors: Ellen Liu, Allison Bigeh, Lauren Ledingham, Laxmi Mehta

Published in: Current Cardiology Reports | Issue 8/2022

Login to get access

Abstract

Purpose of Review

Cardiovascular disease remains the leading cause of morbidity and mortality in women. Women were historically underrepresented in landmark trials for which cardiovascular guidelines are based on and are prone to gender-specific risk factors that predispose to coronary heart disease.

Recent Findings

More attention has been made on gender and pregnancy-associated risk factors such as autoimmune disorders and preeclampsia. The most recent guidelines have reflected the need to consider risk-enhancing factors that are unaccounted for in traditional risk assessment tools.

Summary

As the population ages and the burden of cardiovascular disease in women increases, it is crucial to continue focusing on preventative of cardiovascular disease in women.
Literature
1.
Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743.PubMedCrossRef
2.
Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK, et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(20):2602–18.PubMedPubMedCentralCrossRef
3.
Medina L, Sabo S, Vespa J. Living longer: historical and projected life expectancy in the United States, 1960 to 2060. Current Population Reports: United States CensusBureau; 2020.
4.
West L, Cole S, Goodkind D, He W. 65+ in the United States: 2010. Current Population Reports: US Census Bureau; 2014.
5.
Jin X, Chandramouli C, Allocco B, Gong E, Lam CSP, Yan LL. Women’s participation in cardiovascular clinical trials from 2010 to 2017. Circulation. 2020;141(7):540–8.PubMedCrossRef
6.
Khan SU, Khan MZ, Raghu Subramanian C, Riaz H, Khan MU, Lone AN, et al. Participation of women and older participants in randomized clinical trials of lipid-lowering therapies: a systematic review. JAMA Netw Open. 2020;3(5): e205202.PubMedPubMedCentralCrossRef
7.
Nanna MG, Wang TY, Xiang Q, Goldberg AC, Robinson JG, Roger VL, et al. Sex differences in the use of statins in community practice. Circ Cardiovasc Qual Outcomes. 2019;12(8): e005562.PubMedPubMedCentralCrossRef
8.
Metser G, Bradley C, Moise N, Liyanage-Don N, Kronish I, Ye S. Gaps and disparities in primary prevention statin prescription during outpatient care. Am J Cardiol. 2021;161:36–41.PubMedCrossRef
9.
Samayoa L, Grace SL, Gravely S, Scott LB, Marzolini S, Colella TJ. Sex differences in cardiac rehabilitation enrollment: a meta-analysis. Can J Cardiol. 2014;30(7):793–800.PubMedCrossRef
10.
Oosenbrug E, Marinho RP, Zhang J, Marzolini S, Colella TJ, Pakosh M, et al. Sex differences in cardiac rehabilitation adherence: a meta-analysis. Can J Cardiol. 2016;32(11):1316–24.PubMedCrossRef
11.
Smith JR, Thomas RJ, Bonikowske AR, Hammer SM, Olson TP. Sex differences in cardiac rehabilitation outcomes. Circ Res. 2022;130(4):552–65.PubMedCrossRef
12.
Huxley RR, Woodward M. Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet. 2011;378(9799):1297–305.PubMedCrossRef
13.
Patel SA, Winkel M, Ali MK, Narayan KM, Mehta NK. Cardiovascular mortality associated with 5 leading risk factors: national and state preventable fractions estimated from survey data. Ann Intern Med. 2015;163(4):245–53.PubMedCrossRef
14.
Choi J, Daskalopoulou SS, Thanassoulis G, Karp I, Pelletier R, Behlouli H, et al. Sex- and gender-related risk factor burden in patients with premature acute coronary syndrome. Can J Cardiol. 2014;30(1):109–17.PubMedCrossRef
15.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women–2011 update: a guideline from the American Heart Association. J Am Coll Cardiol. 2011;57(12):1404–23.PubMedPubMedCentralCrossRef
16.
Faccini A, Kaski JC, Camici PG. Coronary microvascular dysfunction in chronic inflammatory rheumatoid diseases. Eur Heart J. 2016;37(23):1799–806.PubMedCrossRef
17.
Katz G, Smilowitz NR, Blazer A, Clancy R, Buyon JP, Berger JS. Systemic lupus erythematosus and increased prevalence of atherosclerotic cardiovascular disease in hospitalized patients. Mayo Clin Proc. 2019;94(8):1436–43.PubMedCrossRef
18.
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107(9):1303–7.PubMedCrossRef
19.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. Circulation. 2019;139(25):e1082–143.PubMed
20.
Honigberg MC, Zekavat SM, Aragam K, Finneran P, Klarin D, Bhatt DL, et al. Association of premature natural and surgical menopause with incident cardiovascular disease. JAMA. 2019;322(24):2411–21.PubMedPubMedCentralCrossRef
21.
El Khoudary SR, Aggarwal B, Beckie TM, Hodis HN, Johnson AE, Langer RD, et al. Menopause transition and cardiovascular disease risk: implications for timing of early prevention: a scientific statement from the American Heart Association. Circulation. 2020;142(25):e506–32.PubMedCrossRef
22.
Rosano GM, Vitale C, Marazzi G, Volterrani M. Menopause and cardiovascular disease: the evidence. Climacteric. 2007;10(Suppl 1):19–24.PubMedCrossRef
23.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018;89(3):251–68.CrossRef
24.
Osibogun O, Ogunmoroti O, Michos ED. Polycystic ovary syndrome and cardiometabolic risk: opportunities for cardiovascular disease prevention. Trends Cardiovasc Med. 2020;30(7):399–404.PubMedCrossRef
25.
Christian RC, Dumesic DA, Behrenbeck T, Oberg AL, Sheedy PF 2nd, Fitzpatrick LA. Prevalence and predictors of coronary artery calcification in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2003;88(6):2562–8.PubMedCrossRef
26.
Meyer ML, Malek AM, Wild RA, Korytkowski MT, Talbott EO. Carotid artery intima-media thickness in polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update. 2012;18(2):112–26.PubMedCrossRef
27.
Diamanti-Kandarakis E, Alexandraki K, Piperi C, Protogerou A, Katsikis I, Paterakis T, et al. Inflammatory and endothelial markers in women with polycystic ovary syndrome. Eur J Clin Invest. 2006;36(10):691–7.PubMedCrossRef
28.
Talbott EO, Zborowski JV, Rager JR, Boudreaux MY, Edmundowicz DA, Guzick DS. Evidence for an association between metabolic cardiovascular syndrome and coronary and aortic calcification among women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2004;89(11):5454–61.PubMedCrossRef
29.
Vaccarino V, Bremner JD. Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev. 2017;74(Pt B):297–309.PubMedCrossRef
30.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–52.PubMedCrossRef
31.
32.
Carney RM, Freedland KE. Depression and coronary heart disease. Nat Rev Cardiol. 2017;14(3):145–55.PubMedCrossRef
33.
Whang W, Kubzansky LD, Kawachi I, Rexrode KM, Kroenke CH, Glynn RJ, et al. Depression and risk of sudden cardiac death and coronary heart disease in women: results from the Nurses’ Health Study. J Am Coll Cardiol. 2009;53(11):950–8.PubMedPubMedCentralCrossRef
34.
O’Neil A, Fisher AJ, Kibbey KJ, Jacka FN, Kotowicz MA, Williams LJ, et al. Depression is a risk factor for incident coronary heart disease in women: an 18-year longitudinal study. J Affect Disord. 2016;196:117–24.PubMedCrossRef
35.
Goldstein BI, Carnethon MR, Matthews KA, McIntyre RS, Miller GE, Raghuveer G, et al. Major depressive disorder and bipolar disorder predispose youth to accelerated atherosclerosis and early cardiovascular disease: a scientific statement from the American Heart Association. Circulation. 2015;132(10):965–86.PubMedCrossRef
36.
Benschop L, Brouwers L, Zoet GA, Meun C, Boersma E, Budde RPJ, et al. Early onset of coronary artery calcification in women with previous preeclampsia. Circ Cardiovasc Imaging. 2020;13(11): e010340.PubMedCrossRef
37.
Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e563–95.PubMedPubMedCentral
38.
Bellamy L, Casas JP, Hingorani AD, Williams DJ. Pre-eclampsia and risk of cardiovascular disease and cancer in later life: systematic review and meta-analysis. BMJ. 2007;335(7627):974.PubMedPubMedCentralCrossRef
39.
Wu P, Gulati M, Kwok CS, Wong CW, Narain A, O'Brien S, et al. Preterm delivery and future risk of maternal cardiovascular disease: a systematic review and meta-analysis. J Am Heart Assoc. 2018;7(2).
40.
Daly B, Toulis KA, Thomas N, Gokhale K, Martin J, Webber J, et al. Increased risk of ischemic heart disease, hypertension, and type 2 diabetes in women with previous gestational diabetes mellitus, a target group in general practice for preventive interventions: a population-based cohort study. PLoS Med. 2018;15(1): e1002488.PubMedPubMedCentralCrossRef
41.
Di Mascio D, Magro-Malosso ER, Saccone G, Marhefka GD, Berghella V. Exercise during pregnancy in normal-weight women and risk of preterm birth: a systematic review and meta-analysis of randomized controlled trials. Am J Obstet Gynecol. 2016;215(5):561–71.PubMedCrossRef
42.
Magro-Malosso ER, Saccone G, Di Tommaso M, Roman A, Berghella V. Exercise during pregnancy and risk of gestational hypertensive disorders: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2017;96(8):921–31.PubMedCrossRef
43.
Howard BV, Van Horn L, Hsia J, Manson JE, Stefanick ML, Wassertheil-Smoller S, et al. Low-fat dietary pattern and risk of cardiovascular disease: the Women’s Health Initiative Randomized Controlled Dietary Modification Trial. JAMA. 2006;295(6):655–66.PubMedCrossRef
44.
Sacks FM, Svetkey LP, Vollmer WM, Appel LJ, Bray GA, Harsha D, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med. 2001;344(1):3–10.
45.
Whelton PK, Carey RM, Aronow WS, Casey DE Jr, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines. J Am Coll Cardiol. 2018;71(19):e127–248.PubMedCrossRef
46.
Barua RS, Rigotti NA, Benowitz NL, Cummings KM, Jazayeri MA, Morris PB, et al. 2018 ACC expert consensus decision pathway on tobacco cessation treatment: a report of the American College of Cardiology Task Force on clinical expert consensus documents. J Am Coll Cardiol. 2018;72(25):3332–65.PubMedCrossRef
47.
Duncan MS, Freiberg MS, Greevy RA Jr, Kundu S, Vasan RS, Tindle HA. Association of smoking cessation with subsequent risk of cardiovascular disease. JAMA. 2019;322(7):642–50.PubMedPubMedCentralCrossRef
48.
Meyers DG, Neuberger JS, He J. Cardiovascular effect of bans on smoking in public places: a systematic review and meta-analysis. J Am Coll Cardiol. 2009;54(14):1249–55.PubMedCrossRef
49.
Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Bohm M, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451–61.PubMedCrossRef
50.
Blaha MJ, Cainzos-Achirica M, Greenland P, McEvoy JW, Blankstein R, Budoff MJ, et al. Role of coronary artery calcium score of zero and other negative risk markers for cardiovascular disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation. 2016;133(9):849–58.PubMedPubMedCentralCrossRef
51.
Silverman MG, Blaha MJ, Krumholz HM, Budoff MJ, Blankstein R, Sibley CT, et al. Impact of coronary artery calcium on coronary heart disease events in individuals at the extremes of traditional risk factor burden: the multi-ethnic study of atherosclerosis. Eur Heart J. 2014;35(33):2232–41.PubMedCrossRef
52.
Gaziano JM, Brotons C, Coppolecchia R, Cricelli C, Darius H, Gorelick PB, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet. 2018;392(10152):1036–46.PubMedPubMedCentralCrossRef
53.
Group ASC, Bowman L, Mafham M, Wallendszus K, Stevens W, Buck G, et al. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529–39.CrossRef
54.
McNeil JJ, Wolfe R, Woods RL, Tonkin AM, Donnan GA, Nelson MR, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379(16):1509–18.PubMedPubMedCentralCrossRef
55.
Caritis S, Sibai B, Hauth J, Lindheimer MD, Klebanoff M, Thom E, et al. Low-dose aspirin to prevent preeclampsia in women at high risk. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. N Engl J Med. 1998;338(11):701–5.
56.
Rolnik DL, Wright D, Poon LC, O’Gorman N, Syngelaki A, de Paco MC, et al. Aspirin versus placebo in pregnancies at high risk for preterm preeclampsia. N Engl J Med. 2017;377(7):613–22.PubMedCrossRef
57.
Hypertension in pregnancy. Report of the American College of Obstetricians and Gynecologists’ Task Force on Hypertension in Pregnancy. Obstet Gynecol. 2013;122(5):1122–31.CrossRef
58.
ACOG Committee Opinion No. 743: low-dose aspirin use during pregnancy. Obstet Gynecol. 2018;132(1):e44–52.CrossRef
59.
Mauricio R, Khera A. Statin use in pregnancy: is it time for a paradigm shift? Circulation. 2022;145(7):496–8.PubMedCrossRef
60.
Dobert M, Varouxaki AN, Mu AC, Syngelaki A, Ciobanu A, Akolekar R, et al. Pravastatin versus placebo in pregnancies at high risk of term preeclampsia. Circulation. 2021;144(9):670–9.PubMedCrossRef
61.
62.
Group SR, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103–16.CrossRef
63.
•• Tita AT, Szychowski JM, Boggess K, Dugoff L, Sibai B, Lawrence K, et al. Treatment for Mild Chronic Hypertension during Pregnancy. N Engl J Med. 2022. Findings from this study show that antihypertensive therapy targeted to a blood pressure <140/90 mmHg improves pregnancy outcomes among pregnant women with mild chronic hypertension.
64.
65.
American College of O, Gynecologists' Committee on Practice B-O. ACOG Practice Bulletin No. 203: chronic hypertension in pregnancy. Obstet Gynecol. 2019;133(1):e26-e50.
66.
• Halpern DG, Weinberg CR, Pinnelas R, Mehta-Lee S, Economy KE, Valente AM. Use of medication for cardiovascular disease during pregnancy: JACC State-of-the-Art Review. J Am Coll Cardiol. 2019;73(4):457–76. Excellent review of medications that may be or should not be used during pregnancy.
67.
Florio KL, DeZorzi C, Williams E, Swearingen K, Magalski A. Cardiovascular medications in pregnancy: a primer. Cardiol Clin. 2021;39(1):33–54.PubMedCrossRef
68.
Design of the Women's Health Initiative clinical trial and observational study. The Women's Health Initiative Study Group. Control Clin Trials. 1998;19(1):61–109.
69.
Anderson GL, Limacher M, Assaf AR, Bassford T, Beresford SA, Black H, et al. Effects of conjugated equine estrogen in postmenopausal women with hysterectomy: the Women’s Health Initiative randomized controlled trial. JAMA. 2004;291(14):1701–12.PubMedCrossRef
70.
Rossouw JE, Anderson GL, Prentice RL, LaCroix AZ, Kooperberg C, Stefanick ML, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA. 2002;288(3):321–33.PubMedCrossRef
71.
Grady D, Herrington D, Bittner V, Blumenthal R, Davidson M, Hlatky M, et al. Cardiovascular disease outcomes during 6.8 years of hormone therapy: Heart and Estrogen/progestin Replacement Study follow-up (HERS II). JAMA. 2002;288(1):49–57.
72.
Salpeter SR, Walsh JM, Greyber E, Salpeter EE. Brief report: Coronary heart disease events associated with hormone therapy in younger and older women. A meta-analysis J Gen Intern Med. 2006;21(4):363–6.PubMedCrossRef
73.
Hodis HN, Mack WJ, Henderson VW, Shoupe D, Budoff MJ, Hwang-Levine J, et al. Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med. 2016;374(13):1221–31.PubMedPubMedCentralCrossRef
Metadata
Title
Prevention of Coronary Artery Disease in Women
Authors
Ellen Liu
Allison Bigeh
Lauren Ledingham
Laxmi Mehta
Publication date
14-06-2022
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 8/2022
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-022-01721-5

Other articles of this Issue 8/2022

Current Cardiology Reports 8/2022 Go to the issue

Congenital Heart Disease(RA Krasuski and G Fleming, Section Editors)

Bicuspid Aortic Valves: an Up-to-Date Review on Genetics, Natural History, and Management

Diabetes and Cardiovascular Disease (D Bruemmer, Section Editor)

Synchronous Health Care Delivery for the Optimization of Cardiovascular and Renal Care in Patients with Type 2 Diabetes

Nuclear Cardiology (V Dilsizian, Section Editor)

The Potential of F-18 Flurpiridaz PET/CT Myocardial Perfusion Imaging for Precision Imaging

Pericardial Disease (AL Klein and CL Jellis, Section Editors)

Pericardial Manifestations of Thyroid Diseases

Myocardial Disease (A Abbate and M Merlo, Section Editors)

The Dynamic Role of Cardiac Macrophages in Aging and Disease

Myocardial Disease (A Abbate and M Merlo, Section Editors)

The Role of B Cells in Cardiomyopathy and Heart Failure

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits