Women miss out on cardiovascular disease treatment, despite it being their 'number one killer'

Tardy treatment patterns

Conventional cardiovascular disease risk factors, such as high blood pressure and high cholesterol, are often not treated as promptly or as appropriately as they are in men, despite accounting for around half of all preventable cardiovascular disease deaths, says the statement.

Women face particular cultural, societal, and financial issues that magnify their heart disease risks, as well as enduring the influence of hormones, pregnancy, and the menopause, across their lifespan, notes the statement. Their biology, physiology, and body shape not only affect their risks of developing cardiovascular disease, but also the effectiveness of diagnostic procedures and treatment, it adds.

Healthcare professionals and the public mistakenly believe that women’s risk of cardiovascular disease is lower than men’s, says the statement. ‘Myths and unconscious biases within clinical practices and societal perceptions further obscure the reality that heart disease does not discriminate by sex,’ Dr Tayal and her colleagues state. And, all too often, women’s voices go unheard and their heart symptoms aren’t taken seriously enough, they add.

The statement sets out a series of actions for clinicians and their professional bodies in each of the major cardiovascular disease areas of coronary artery disease, valvular disease, heart failure, inherited heart disease, congenital heart defects and heart rhythm disorders.

Despite significant progress in the management of [cardiovascular disease], it remains the UK’s number one killer for women. Unfortunately, women are underdiagnosed, undertreated, and under-represented in all [cardiovascular disease] areas, [says statement]

Actions needed include

• raising awareness of traditional and women-specific risk factors for all types of cardiovascular disease
• ensuring that women are included in cardiovascular disease research
• making sure that the public and clinicians know that coronary artery disease is the leading cause of death for women
• ensuring equitable access to specialist cardiac care, genetic testing, and family screening for women with inherited heart disease
• addressing the under-representation of women in clinical trials of new cancer immunotherapy treatments
• setting up registries to monitor cardiac toxicity as a result of cancer chemotherapy for everyone, and specifically for women
• enhancing women’s participation in cardiac rehabilitation programmes by offering flexible hybrid/virtual options
• increasing clinician awareness of the strengths and limitations of each diagnostic method in women with confirmed or suspected cardiovascular disease
• making women’s cardiovascular disease health ‘everyone’s responsibility’ by including this in primary care clinicians’ contractual obligations
• leveraging influence to highlight and address sex biases in health care

Role for patients and supporters

Meanwhile, patients and those advocating on their behalf also have a role in advancing women’s cardiovascular disease care, should

• call for a holistic woman-centred approach to heart care that incorporates women’s experiences and insights
• engage the media, among others, to raise awareness about the importance of cardiovascular health for women 
• tailor information to the unique needs of women
• highlight heart conditions that predominantly or exclusively affect women
• co-design training for healthcare professionals to become more attuned to women’s specific needs

The statement also calls for the establishment of women’s heart champions to offer peer to peer support and dedicated women’s heart hubs to check on conventional risk factors, such as blood pressure, cholesterol, and weight, and provide lifestyle advice on diet and exercise. A dedicated women’s health strategy should be created, it suggests.

Role for health professionals and professional bodies 

Health professionals, professional bodies, charities and the NHS can play their part by mounting coordinated campaigns with unified messages that raise the profile of women’s heart health, the statement says.

‘Despite significant progress in the management of [cardiovascular disease], it remains the UK’s number one killer for women. Unfortunately, women are underdiagnosed, undertreated, and under-represented in all [cardiovascular disease] areas,’ it notes. 

Implementing the recommendations will help to ‘address the sex disparities in everyday care of patients in all settings, aiming at saving many women from losing their lives unnecessarily from preventable conditions in the UK and also worldwide', the statement concludes.

British Cardiovascular Society's view

André Ng is the president of the British Cardiovascular Society, which co-owns Heart with BMJ Group. He commented: ‘The joint British Cardiovascular Societies' consensus document is the first to comprehensively detail the many layers of inequalities that exist in relation to cardiovascular disease in women, who clearly need better access to early and accurate diagnosis and timely treatment. Raising awareness across the medical profession, to patients and the general public is an important first step.' 

Professor Ng added: ‘The British Cardiovascular Society will work with our affiliated societies in all areas of cardiology as well as other stakeholders, including patient organisations and NHS leaders, to identify key work packages that will bring transformative change to improve care and achieve better outcomes for cardiovascular care in female patients.’

To access the full version of the consensus statement – titled Advancing the access to cardiovascular diagnosis and treatment among women with cardiovascular disease: a joint British Cardiovascular Societies’ consensus document Doi 10.1136/heartjnl-2024-324625 – click