Pharmacy U presenter Paula Harvey: Women's cardiovascular health
Pharmacists are in a unique position to provide counselling and support to women with risk factors for CVD, and to advise on the implementation of lifestyle and pharmacological interventions to optimize primary and secondary preventions strategies.
Cardiovascular disease (CVD) is the leading cause of premature death in Canadian women. While CVD mortality has been steadily declining in many regions of the world, women continue to have disproportionately worse outcomes than men. The statistics are particularly concerning for younger women. The top 3 CVD-related causes of death for women in Canada are obstructive epicardial coronary artery disease (CAD) causing ischemic heart disease (IHD), stroke, and heart failure (HF). There are also additional cardiac conditions such as spontaneous coronary artery dissection (SCAD), coronary microvascular disease, coronary artery spasm and Takotsubo Syndrome that have a strong female preponderance and contribute significantly to cardiovascular (CV) mortality, morbidity and disability in women.
The reasons underlying the differences in CVD burden and outcomes between men and women are complex and multifactorial. They include both biological/physiological/genetic and sociocultural factors such as gender, culture/ethnicity, socioeconomic, and mental health factors. We are learning that these factors impact CV health and outcomes differently in women versus men. We need further research into CVD in women as a priority, because under-representation of women in CVD research studies continues to be a significant contributing factor to the under recognition, under-diagnosis, under-treatment, and under support of women with CVD in Canada. These are known as the “5 unders”. Research into the complex interplay between sex/biological and gender-specific differences in comorbidities, risk factors, disease awareness, presentation, diagnosis, and treatment across the entire spectrum of CVD will lead to reduced CVD burden and improved outcomes in Canadian women.
While it is clear we need this further research, there are practical steps that we should implement immediately to improve the burden and outcomes of CVD in women. Cardiovascular risk factor awareness and cardiovascular primary and secondary prevention strategies should be a priority across a woman’s lifespan. Women and health providers need to understand the importance of recognizing and treating CV risk factors early and effectively to reduce CVD burden.
It is not well known by women or health professionals that “traditional” cardiovascular risk factors including diabetes, hypertension, smoking, dyslipidemia, depression, and lifestyle factors such as sedentary lifestyle, poor diet and overweight/obesity portend greater risk for CVD in women than men. They are also often less well controlled. Furthermore, multiple “novel” emerging female specific risk factors that include gestational diabetes, hypertensive disorders in pregnancy, polycystic ovarian syndrome (PCOS), autoimmune diseases (such as systemic lupus erythematosus and rheumatoid arthritis), and a history of breast cancer have been identified as contributing to elevated CV risk over a woman’s lifespan.
The lack of awareness and attention to all these risk factors from both a community/individual and health professional perspective is a missed opportunity to improve women’s CVD prevention, CV disease management and overall support.
Pharmacists are in a unique position to provide counselling and support to women with risk factors for CVD, and to advise on the implementation of lifestyle and pharmacological interventions to optimize primary and secondary preventions strategies. They can highlight CV risk factors and management when women are dealing with other competing chronic diseases that may in their mind be of higher priority and more immediate, often combined with competing socioeconomic factors, and even caregiver burden. Women often do not prioritize their health over that of loved ones particularly when they are a caregiver. In this session we will explore how pharmacists have the unique opportunity to advocate for and implement strategies to improve women’s CV health at the coalface, and to ultimately help reduce the burden of cardiovascular disease in Canadian women.