Cardiovascular health disparities across the female lifespan

Women’s cardiovascular disease risks and outcomes differ across the lifespan from those of men, according to a collection of Cardiovascular Research studies focusing on women of all ages published today in a special Spotlight number of Journal of the American Heart Associationa peer-reviewed open access journal of the American Heart Association.

Cardiovascular disease kills more women than all forms of cancer combined. Among women 20 and older, nearly 45 percent live with some form of cardiovascular disease, and less than 50 percent of women who become pregnant in the U.S. have good heart health. Also, more than half of deaths from high blood pressure are in women. Yet women make up only 38 percent of participants in cardiovascular disease clinical trials, according to the American Heart Association.

The magazine’s special Go Red for Women issue, in recognition of American Heart Month, features studies that reveal insights such as: how diet may affect the high risk of preeclampsia in Hispanic/Latina pregnant women; how women were less likely than men to receive CPR and treatment with an automated external defibrillator (AED) and to survive the first 30 days after hospitalization after an out-of-hospital cardiac arrest; and how rehospitalization rates differ among women with heart failure and obstructive sleep apnea. In another study presented, researchers reported that while the incidence of intracerebral hemorrhage (bleeding in the brain), the second most common type of stroke, was lower in women, women were more likely to die one year after a stroke than men.

Below are highlights of some of the manuscripts in this issue,

• Prospective associations of accelerometer-measured machine-learned sedentary behavior with mortality among older women: The OPACH Study

Steve Nguyen, MD, et al.; University of California, San Diego, La Jolla, CA

This team examined sedentary behavior patterns in nearly 6,000 older women (mean age 79 years) to determine the impact of time spent sitting on cardiovascular and all-cause mortality. Using a measurement tool powered by machine learning to accurately classify sitting time, the researchers found that those who sat for more than 11.6 total hours per day and had longer periods of continuous sitting had 57 % higher risk of death from any cause and 78% increased risk of death from cardiovascular disease. This was compared to women who sat for less than 9.3 hours a day. The increased risk of death was consistent regardless of age, body mass index, physical functioning, cardiovascular disease risk factors, physical activity intensity, and race/ethnicity. Reducing overall sedentary behavior and continuous sitting time is likely to have major public health benefits in an aging society, according to researchers.

• Gender differences in the relationship between schizophrenia and the development of cardiovascular disease

Hidehiro Kaneko, MD, Ph.D., et al.; University of Tokyo, Tokyo, Japan

Researchers examined the risk of cardiovascular disease in people with schizophrenia, a major psychotic disorder and one of the 15 leading causes of disability worldwide. Schizophrenia is a severe, chronic mental illness characterized by disturbances in perception, thinking, and behavior. The study found a strong link between schizophrenia and the risk of developing cardiovascular disease in adults, but especially in women. This higher risk in women may be related to hormonal changes during pregnancy and menopause or reports that women are more sedentary than men. However, the findings point to the need for healthcare professionals to take a comprehensive and gender-focused approach to cardiovascular disease prevention because of the prominent role that schizophrenia appears to play in cardiovascular disease. The researchers suggest that it is extremely important to encourage physical activity, especially among women with schizophrenia, because lack of activity may have increased the risk in the female participants in this study. Health care providers should routinely screen for and treat schizophrenia as part of standard clinical practice, with special attention to women, the authors write.

• Maternal dietary patterns during pregnancy are associated with hypertensive disorders during pregnancy in a predominantly Hispanic/Latina low-income pregnant cohort

Luis E. Maldonado, Ph.D., MPH, et al.; Keck School of Medicine, University of Southern California

In a study of more than 400 mostly low-income, pregnant Hispanic/Latina women in Los Angeles, researchers found that a diet characterized by higher intakes of solid fats, refined grains, and cheese was strongly associated with higher odds have a hypertensive pregnancy disorder, including preeclampsia during pregnancy.

Other documents in the spotlight issue include:

• Association of sex with cardiovascular outcomes in heart failure patients with obstructive or central sleep apnea -; Jian Zhang, MD, Ph.D., et al.; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
• Pregnancy history at age 40 as a marker of cardiovascular risk -; Liv G. Kvalvik, MD, Ph.D., et al.; University of Bergen, Bergen, Norway
• Gender differences in the epidemiology of intracerebral hemorrhage over 10 years in a population-based stroke registry -; Simona Sacco, PhD, et al.; University of L’Aquila, L’Aquila, Italy
• Gender differences in revascularization, treatment goals, and outcomes in patients with chronic coronary disease: Insights from the ISCHEMIA study -; Harmony R. Reynolds, MD, FAHA, et al.; NYU Grossman School of Medicine, New York
• Gender differences in receipt of bystander CPR given neighborhood racial and ethnic composition -; Audrey L. Blewer, Ph.D., MPH, et al.; Duke University, Durham, North Carolina
• Hypertension during pregnancy among immigrant and Swedish women – Cohort study of all pregnant women in Sweden -; Axel C. Carlsson, Ph.D., et al.; Karolinska Institutet, Hudinge, Sweden
• Gender differences in survival trends for out-of-hospital cardiac arrest -; RLA Smits, et al.; Amsterdam University Medical Center, Amsterdam, The Netherlands;
• Posttraumatic stress disorder is associated with increased risk of stroke and transient ischemic attack in female veterans -; Ramin Ebrahimi, PhD, et al.; University of California, Los Angeles; Los Angeles Veterans Affairs Health System, Los Angeles; and
• Gender differences in outcomes of acute myocardial injury after stroke -; Michela Rosso, PhD, et al.; University of Pennsylvania, Philadelphia.