AHA: Consider adverse social factors, racism when assessing CVD risk for women
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Key takeaways:
- An American Heart Association scientific statement highlights considering social determinants of health when assessing CVD risk in women.
- Considering non-biological variables can improve equity in care.
Clinicians must consider adverse social factors and nonbiological variables, such as language barriers, health care access and discrimination, to better address CVD risk among women from underrepresented backgrounds, researchers reported.
In a scientific statement from the American Heart Association, researchers also wrote that CV risk assessment calculators must be updated to include social determinants of health and nonbiological variables specifically to address CVD among women from underrepresented race groups.
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“We need for an urgent call to action as CVD, which is largely preventable, remains the leading cause of death for women in the U.S. and we are seeing a reversal of the progress made since the focus on the sex and gender aspects of CVD that began in the early 2000s and since the launch of the AHA's Go Red For Women campaign in 2004,” Jennifer H. Mieres, MD, FAHA, FACC, MASNC, professor of cardiology and chief of diversity and inclusion at the Zucker School of Medicine at Hofstra/Northwell in Hempstead, N.Y. and vice chair of the scientific statement writing committee, told Healio. “Importantly, the statistics demonstrate a bleak view for women of color and particularly Black women, who have the highest burden of CVD deaths and morbidity and the highest burden of risk factors for CVD.”
Overall, 44% of women of women over age 20 years are living with some form of CVD, only 44% of women are aware that CVD is their leading cause of death and only 42% of cardiologists report feeling prepared to adequately assess CVD specific to women, Mieres said.
Limitations to traditional risk factors
The statement notes that there are many limitations to traditional risk factors and their ability to comprehensively estimate a person’s risk for CVD.
“For example, BMI is often used as a means to identify obesity; however, it is not an ideal metric in people of underrepresented races and ethnicities such as Asian individuals,” the researchers wrote.
Current risk assessment models do not consider sex-specific biological risk factors, such as pregnancy-related factors, menstrual cycle history, medications like contraception or hormone therapy, and medical conditions like polycystic ovary syndrome.
“Mental health conditions are an additional nontraditional risk factor that have a significant effect on cardiovascular health,” the researchers wrote. “Women have anxiety and depression disproportionately to men and are nearly twice as likely as men to be diagnosed with depression. Depressed mood can occur as a result of normal hormonal changes associated with puberty, menstruation, pregnancy, perimenopause and menopause.”
Consider environmental, cultural stressors
Environmental and cultural stressors are associated with a higher incidence of depression in women, the statement notes, adding that psychosocial stressors such as discrimination, poor social support, domestic violence, primary elder and child caregiving roles and unequal power dynamics in the workplace play a significant role and may increase the risk for depression in women.
Clinicians should incorporate screening for mental health conditions such as depression and PTSD, which are more common in women and are associated with a higher risk for developing cardiometabolic risk factors and incident CVD.
Culturally sensitive education needed
Social determinants of health play a significant role in the development of CVD among women, with disproportionate effects on women from diverse racial and ethnic backgrounds, the researchers wrote. Factors include economic stability, neighborhood safety, working conditions, environmental hazards such as air pollution, education level and access to quality health care. These factors are common in communities of underrepresented races and ethnicities and pose a significant challenge in the diagnosis of CVD and the application of treatment modalities, the researchers wrote.
The statement notes that culturally sensitive, peer-led community and health care professional education is a “necessary step” in CVD prevention.
“Equitable access to guideline-approved, evidence-based cardiovascular preventive health care based on available data should be available for all women regardless of race and ethnicity,” the researchers wrote. “Despite this knowledge, these guidelines are not equally incorporated into practice, which highlights a call to action.”
In a press release, Laxmi S. Mehta, MD, FAHA, director of preventive cardiology and women’s cardiovascular health at the Ohio State University Wexner Medical Center and chair of the scientific statement writing group, said that expanding risk assessment to include social determinants of health as risk factors is vital to improve health outcomes in all women.
“It is also important for the health care team to consider social determinants of health when working with women on shared decisions about cardiovascular disease prevention and treatment,” Mehta said in the release.
For more information:
Jennifer H. Mieres, MD, FAHA, FACC, MASNC, can be reached at jmieres@northwell.edu.
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