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Cardiovascular disease (CVD) is the leading cause of death for women in Canada, claiming a life every 20 minutes. Heart attacks go unrecognized in women up to 54 per cent of the time. This is because women often present with different symptoms than men, leading to later diagnosis and treatment. 

Women also have unique considerations that may impact their cardiovascular health, yet they have historically been under-represented when it comes to cardiovascular research. 

Several ��ݮ����Ƶ���� researchers are working to change that as part of a group of experts creating the Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women. Published in CJC Open, when finished over a two-year period, the ATLAS will provide a comprehensive update on women’s cardiovascular health in Canada, along with the latest in clinical care, based on the latest scientific evidence. 

Researcher-clinicians Drs. Kara Nerenberg, MD, Sandra Dumanski, MD, and Sofia Ahmed, MD, contributed to of the ATLAS, entitled “Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman.” The chapter outlines the unique sex- and gender-related risk factors for (CVD) that can present or evolve over a woman’s lifespan. 

“This chapter is about the CVD risk factors unique to women from puberty to postmenopausal health and how different risk factors arise during different times of a woman’s life,” says Nerenberg, who holds the Women’s Heart and Brain Health Mid-Career Research Chair supported by the Canadian Institutes of Health Research and Heart & Stroke.

“The unique focus of this chapter is highlighting to physicians the conditions in every age cycle to watch for.” For example, the age of onset of puberty, as well as menopause, impacts a woman’s risk of developing CVD later in their life. Pregnancy-associated conditions, like hypertensive disorders of pregnancy, polycystic ovarian syndrome, and autoimmune rheumatic disorders, which are more prevalent in women, can also increase a female’s risk of developing CVD. 

Traditional CVD risk factors like smoking, diabetes, hypertension, depression, anxiety, and family history, have a greater influence in women than men. There are also sex differences in the way females respond to treatments. 

Nerenberg says this fourth chapter, of nine to be included in the ATLAS, acts as a reminder for health-care providers to ask women about their reproductive histories. Considering women’s risk factors may help health-care providers offer ways to reduce that risk and help them recognize more readily that a woman is having a cardiovascular episode. 

Dumanski, a busy clinician-researcher whose research focuses on the implications of female fertility on cardiovascular health, has a keen interest in closing clinical care gaps for women. 

“We know there are disparities for women across the age cycle, and I think it is really important that physicians, and all women, are aware of these risk factors,” she says. “We treat men and women the same when it comes CVD, even though we know there are differences. The goal of the ATLAS is to increase equity in this area.” 

Another goal is to educate health-care practitioners, and women, on the most up-to-date science and treatment guidelines. Dumanski thinks the information is critical. 

“This applies to every single woman, so all women need to be aware of their potential risk factors,” she says. “It’s not just about the female reproductive organs, it’s the whole woman, including her comorbidities and how she responds to treatments. Her whole biology should be considered.” 

Nerenberg says looking at women’s cardiovascular health is an important step toward implementing precision medicine, which aims to treat patients as individuals with unique health considerations. 
“Women’s cardiovascular health is one of the first being addressed through an equity and diversity lens,” says Nerenberg. “There is still a lot of work to be done.”