A new Lancet commission comprising global experts in cardiology aims to bring about a major shift in thinking about women and heart disease.
Announced on International Women’s Day, the Lancet Commission on women and cardiovascular disease will address the gender gap in heart disease outcomes.
“Cardiovascular disease is the leading cause of death in women worldwide. Ischaemic heart disease accounts for a third of all female deaths globally.
“Yet despite this massive burden and regional advocacy to raise awareness, cardiovascular disease in women is a silent killer,” spells out the announcement, made by Roxana Mehran and colleagues in The Lancet.1
Lack of awareness of the prevalence and symptoms of heart disease in women mean they often delay seeking help and, when they do, they consistently get worse care.
Women are less likely to receive an early diagnosis and those with symptoms of heart attack are less likely to receive timely intervention, such as aspirin, or be resuscitated, compared with their male counterparts.
“These factors contribute to the disproportionately higher mortality in women with cardiovascular disease than men,” comments an editorial in the same edition.2
Shift in thinking
“A major shift in thinking is required to realize that traditional medical textbooks and many public and professional assumptions about who gets and dies from heart disease, and how it manifests, are simply wrong.”
A large part of the problem is a lack of cardiovascular clinical research in women. Despite 50 percent of heart disease occurring in females, guidelines are often extrapolated from predominantly male studies.
This gender bias “stems from a historical failure to ensure gender balance in cardiology research,” the editorial stresses. “The historic failings of cardiology to take a balanced approach to research have led to fundamental flaws in the care of women with heart disease and has cost the lives of many women.”
Reasons for this include a higher prevalence of comorbidities and generally older age in females with cardiovascular disease, explains Mehran’s article. Child-bearing potential is a common exclusion criterion in clinical trials, preventing younger women from participating, the authors add.
“The underlying reasons for the under-representation of women in clinical trials are complex and exploration of additional causes, such as sociocultural issues including gender bias, are crucial to tackle the gap in scientific evidence on women with cardiovascular disease,” they note.
The all-female commission will:
- Summarize the existing scientific evidence and outline gaps in research and care for women with cardiovascular disease
- Present concrete recommendations for addressing related gaps, drawing on best practices from medical and non-medical fields
- Showcase leaders, innovators, and advocates for women with cardiovascular disease
- Generate global awareness about sex-specific disparities in cardiovascular disease and prompt needed additional research
- Provide a springboard into future activities furthering the impact of the commission
- Mehran, R., Vogel, B., Ortega, R., Cooney, R., & Horton, R. (2019). The Lancet Commission on women and cardiovascular disease: time for a shift in women’s health. The Lancet. Retrieved from https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30315-0/fulltext?dgcid=raven_jbs_etoc_email
- Lancet, The. (2019). Cardiology’s problem women. Retrieved from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30510-0/fulltext?dgcid=raven_jbs_etoc_email