Editorial

Now is an excellent time for women's cardiovascular care in America

Ana G. Múnera Echeverri

FACC. FSIAC. FeSISIAC / Hospital General de Medellín.

Corresponding author’s address
Dra. Ana G. Múnera Echeverri. FACC. FSIAC. FeSISIAC
Hospital General de Medellín
Postal address: Carrera 48 32 - 102, Medellín, ANT 050015, Colombia
E-mail

INFORMATION  

Received June 3, 2022 Accepted after review June 6, 2022 www.revistafac.org.ar

There are no conflicts of interest to disclose.

Keywords:
Women.
Cardiovascular care.
America

The total population of America was 1.010 billion in 2019, with a 31% increase over the last 25 years: 50.7% is constituted by women (515 millions), that is to say, 10 more million women than men. The demographic transition observed in year 1995 is still going on currently, with the shift to an elderly population, with an increase in life expectancy from 72.3 to 76.9 years[1]. To this, we may add the longer life expectancy for women than men.

Mortality in America shows a predominance of noncommunicable diseases (NCDs), included cardiovascular diseases, cancer and diabetes, among others, which represent 77% of all deaths in year 2000, and increased to 81% in 2016[1]. The United Nations General Assembly identified cardiovascular diseases as a goal to reduce early mortality by noncommunicable diseases by a third by 2030[2].

The campaigns made have helped to raise awareness on the impact of cardiovascular diseases in women. In spite of these efforts, a standstill has occurred in the general reduction of the load of cardiovascular diseases in women in the last decade. Cardiovascular diseases in women are still little studied, poorly identified, poorly diagnosed and poorly treated[3].

Although work has been done from different scenarios and awareness about cardiovascular diseases has improved in the last decade, bigger efforts and different strategies are required, since the medical community and patients still do not consider cardiovascular disease in women as important and transcendental as it truly is.

For this reason, this Editorial is called “Now is an excellent time for women's cardiovascular care in America”. The study published in this issue called “Perception, knowledge and preventive behaviors for cardiovascular disease among Argentine women”, conducted by Dr. Mildren del Sueldo et al, of the Committee on Cardiovascular Disease (CVD) in Women, of the Federación Argentina de Cardiología (FAC), made a survey on a very significant number of patients, with representation of women from the capital city and other provinces[4], with the aim of identifying the perception of women in Argentina about: knowledge on CVD, preventive behaviors, level of awareness about their own risk and risk factors only for women.

Surveyed women were requested to select between 12 diseases, which they considered was the main health issue in women, pointing first at cancer, while a minority (11%) proposed that CVD is the main health care issue. In reply to the questions “What do you think is the main cause of death between women”, 48% replied violent death/homicide, cancer held the second place and CVD appears with only 16%.

The surveys made in the countries of the region show results similar to those found in this study: CVD was acknowledged as the main cause of death only by 20% in an Argentine survey in 2006, by 12% of Uruguayan women in year 2013, and by 14.4% women in Santiago de Chile[5,6,7]. In the study made by the Sociedad Colombiana de Cardiología y Cirugía Cardiovascular, in year 2008, and a second measurement in year 2017, it was found that the perception about the main health issue affecting women was breast cancer (27%), followed by general cancer (25%), while heart disease held the eighth place (3%). When asked about the main cause of death, most women considered cancer in general in the first place (39%), and breast cancer (21%) in the second place, and in the third place, cardiovascular disease (10%), both in the 2008 and 2017 measurements[8].

The study made by Del Sueldo et al, for the first time asks about the prevalence of factors only of women and information related to hormonal state and pregnancy, which is essential in the evaluation of cardiovascular risk and prevention in women. Eighty-one percent of the surveyed women stated having been pregnant; from these 24% had hypertension with no previous history, 9% were diagnosed with gestational diabetes, 18% had a preterm delivery before the 37th week, and 9% before the 34th week. This set of results produce endothelial damage in the short term, metabolic syndrome in the medium term, and cardiovascular disease in the long term[9,10]. The addition of these percentages and the real number of women to which they correspond (because on occasions more than one event may appear simultaneously) represent a golden chance for cardiovascular disease prevention in a very high percentage of the population studied, where care should be provided not just during the three trimesters of gestation, but also during the fourth trimester, meaning the rest of the life of women[9,10].

The efforts made for education on healthy lifestyles were evident in this study when women were asked about the strategies to reduce cardiovascular risk, since 98% of the interviewed women manifested that lowering their weight, reducing cholesterol, quitting smoking, decreasing salt consumption and performing physical activity contributed significantly to prevention.

This study provides valuable information for future strategies, for instance:

1. Emphasizing and educating about atypical symptoms and manifestations, since in the study most patients identified typical symptoms such as precordial oppression and pain as manifestations of a heart attack, but less than half related an acute event to pain in arms, shoulders, neck or dyspnea, and just a minority identified other symptoms.

2. Performing campaigns including the Internet and social media. In the study, those who had information about CVD in 39% of the cases was through the Internet and 38% through social media.

3. Including gynecologists and general practitioners as a fundamental pillar for education, since the question When was the last time you went to a physician was answered in 65% of cases as the specialty consulted being gynecology or general medicine, while cardiology was 8% of cases.

The study presented showed that current knowledge by Argentine women about CVD as the main cause of disease and death is not enough, in spite of efforts made by the two societies of cardiology, and being among the leading countries in CVD prevention in women. In 2019, the AHA repeated the survey and compared their results with the 2009 survey, finding similar results[11]. In the results from the Colombia study, no significant differences were found between the 2008 and 2017 results, in none of the items related with the main health issue perceived, main cause of death, information received about cardiovascular disease and cardiovascular risk perception in general[8].

This reality poses a great challenge for scientific societies, governments, health care systems in America and the community in general. It is necessary to design new, innovative strategies, different from those carried out in the past. This is a good time for cardiovascular care in women in America, because besides this outstanding study, the same survey is being applied in Uruguay and Chile, and soon we will have the comparison between these three countries. Also, a survey is made by an initiative of the ANCAM (Asociación Nacional de Cardiólogos de México) and its section of Heart Diseases in Women, with the participation of Latin America through the Inter-American Society of Cardiology (IASC Women), called ENAFARC LATAM (Encuesta de Factores de Riesgo Cardiovascular en la Mujer Latinoamericana – Survey on Cardiovascular Risk Factors in Latin American Women). And recently, the Guidelines of Clinical Practice of the IASC on primary prevention of Cardiovascular Disease in Women have been published[12]. All of the above will provide the knowledge on the reality of cardiovascular disease on women in America, and in turn, we will have a theoretical framework to achieve once and for all, an impact on cardiovascular disease in women in the continent.

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