Table 1
Disparities in cardiovascular risk factors by sex and race. BP: blood pressure; CV: cardiovascular; HDL: high-density lipoprotein; CVD: cardiovascular disease
| RISK FACTOR | INCREASES RISK IN MEN/WOMEN | DISPARITIES IN RECOGNITION, MANAGEMENT, AND OUTCOMES | INFLUENCE OF RACE |
|---|---|---|---|
| Traditional | |||
| Hypertension | Women (post-menopause) | Women less likely to have hypertension recognized and treated; less BP control | More prevalent and severe in Black women; higher risk of complications |
| Obesity | Both, higher in women | More stigmatized in women; women respond differently to weight-loss interventions | Black women have the highest rates; disparity less pronounced in men |
| Diabetes | Higher relative risk in women | Women less likely to achieve care goals; higher CV event risk | Higher incidences in racial minorities; differences in severity of complications |
| Cigarette smoking | Higher relative risk in women | Harder time quitting for women; more severe CV consequences | Variations in smoking prevalence and cessation rates by race and gender |
| Dyslipidemia | More atherogenic patterns in women from infancy to early adulthood and middle to old age | Lipid abnormalities less aggressively treated in women | Racial differences in lipid profiles; Black women have higher HDL but also triglycerides |
| Nontraditional | |||
| Autoimmune conditions | More prevalent in women, increasing CVD risk | Women with autoimmune conditions may not receive equal CVD risk assessment | Black women at greater risk due to immunologic and socioeconomic disparities |
| Prediabetes/metabolic syndrome | Impacts both, higher CVD risk in women | More severe cardiovascular outcomes in women | Higher prevalence and impact in Hispanic and Black women |
| Cancer treatments | Unique challenges for women with breast cancer and men with prostate cancer | Cardiovascular impact more pronounced in women; increased risk of cardiomyopathy post-anthracycline therapy | Black women at higher CVD risk due to aggressive cancer types and treatment access |
| Race differences | Higher rates of hypertension and earlier onset of CVD in Black patients | Higher prevalence of hypertension among Black patients; women compounded by delayed diagnosis | Socioeconomic status, healthcare access, and cultural barriers contribute to disparities |
Figure 1
Key female-specific risk factors for cardiovascular disease across a woman’s reproductive lifespan. PCOS: polycystic ovary syndrome; ART: assisted reproductive technology; CVD: cardiovascular disease
Table 2
Factors contributing to worse outcomes in women with acute coronary syndromes. CABG: coronary artery bypass grafting; EKG: electrocardiogram
| Patient factors |
| Delay in seeking care Smaller diameter coronary and peripheral arteries Underappreciated nontraditional risk factors Later age and more comorbidities at the time of event Longer hospital stays Higher risk of complications, including access site bleeding |
| Provider factors |
| Longer door-to-balloon time: delay in getting EKG, delay in seeing provider Less likely to undergo coronary angiography Less likely to receive optimal medical therapy Less likely to receive ideal surgical techniques in CABG, including use of arterial grafts Less likely to be treated with mechanical circulatory support devices |
| System factors |
| Male-specific reference lab values |
Table 3
Strategies for eliminating disparities in cardiovascular health.
| Patient Factors |
| Improve public health messaging around risk and symptoms |
| Provider Factors |
| Rely on validated scoring systems such as HEART, GRACE, and TIMI to risk stratify and guide management Radial first approach for interventions Recognize comorbidities that heighten risk of cardiovascular disease, such as rheumatologic disease, radiation to the chest, and factors related to pregnancy/fertility and its complications Standardize documentation to ensure optimal medical therapy at the time of discharge |
| System Factors |
| Utilize sex-specific reference lab values, consider sex-specific end points and analyses in study designs Develop criteria for assessing valvular disease severity that is specific to sex or indexed to body surface area Increase representation of women in clinical trials Identify and address barriers to women’s participation in clinical trials, such as childcare, transportation, financial constraints, language barriers Increase presence of women in academic cardiology settings and journal editorial boards Formalize mentorship programs in academia and research settings |