A Lancet Commission report released on 16 May states that cardiovascular disease (CVD) causes 35% of deaths in women worldwide, with mortality increasing for young women. It is the first global report on this disease among women, and was presented by the all-women-led commission at the American College of Cardiology’s 70th Annual Scientific Session.
At the launch, the commission co-chairs presented the key findings of the presentation “Lancet Women and Cardiovascular Disease Commission: reducing the global burden by 2030”. They also outlined 10 priority recommendations to achieve this. The report was authored by 17 experts from 11 countries, including the University of Cape Town’s (UCT) acting deputy dean for research in the Faculty of Health Sciences, Professor Liesl Zühlke, a paediatric cardiologist attached to the Red Cross Children’s War Memorial Hospital and Groote Schuur Hospital. Professor Zühlke was the only African among the commissioners.
The commission’s call to urgently address and reduce CVD in women aligns with the United Nations Sustainable Development Goals. These are aimed at reducing premature deaths from non‑communicable diseases, including CVD, by one-third by 2030.
The authors’ 10 recommendations include tackling inequities in diagnosis, treatment, and prevention to reduce CVD in women, including educating healthcare providers and patients on early detection to prevent heart disease in women; scaling up heart-health programmes in highly populated and underdeveloped regions; and prioritising sex-specific research on heart disease in women and intervention strategies. A report, also titled The Lancet Women and Cardiovascular Disease Commission: reducing the global burden by 2030, will be published with The Lancet.
The report states that in 2019, 275 million women were diagnosed with the disease and 8.9 million women died because of the disease. The leading cause of death from CVD in 2019 was ischaemic heart disease (47% of deaths) and stroke (36% of deaths). Despite being the leading cause of death in women each year, CVD in women remains under-studied, under-recognised, under-diagnosed and under-treated, with women under-represented in clinical trials.
“The report states that in 2019, 275 million women were diagnosed with the disease and 8.9 million women died because of the disease.”
The report states that there are considerable geographical differences in CVD, with the highest age-standardised prevalence in North Africa and the Middle East; specifically, Egypt, Iran, Iraq, Libya, Morocco and the United Arab Emirates. The countries with the lowest prevalence are South American: Bolivia, Peru, Colombia, Ecuador and Venezuela. (Age standardisation is a technique that allows populations to be compared when the age profiles of those populations are quite different.)
The report says that evidence of significant regional trends highlights the need for improved data collection at local and regional levels, to effectively present, recognise and treat the disease in women.
Rise in populous, industrialising nations
Although the prevalence of CVD among women has declined by an overall 4.3% since 1990, some of the world’s most populous nations have seen an increase, including China (10% increase), Indonesia (7%), and India (3%). These increases indicate a need for initiatives to expand the prevention, diagnosis and treatment of the disease among women in highly populated and industrialising nations.
The biggest risk factor for women is high blood pressure, followed by high body-mass index and high low-density lipoprotein (LDL) or ‘bad’ cholesterol. The report said that while these well-established risk factors might affect women differently to how they affect men, there are also sex-specific risk factors, such as premature menopause and pregnancy-related disorders, that must be more widely recognised and prioritised for treatment and prevention.
Risks to African women
Importantly for women in Africa, the commissioners pinpointed several under-recognised CVD risk factors that require attention: unemployment (linked to anxiety and depression) and inequalities related to socioeconomic and cultural status, race and poverty.
“Being the leading killer of women globally, cardiovascular disease must take precedence for our attention and action.”
Cultural, political or socioeconomic factors also contributed to women’s health disparities. For example, some social or religious norms restricting women’s participation in sports and physical activities can contribute to cardiovascular disease. This highlights an urgent need for culturally appropriate initiatives tailored to different regions and populations.
Increasing awareness of the disease among physicians, scientists and healthcare providers is also important, and the report adds that there is an unmet need for CVD prediction.
Commenting on the results, Zühlke said, “The momentum to strive for equity and equality more broadly for women, socially and culturally, translates to an extraordinary time to channel that same energy into improving women’s health. Being the leading killer of women globally, cardiovascular disease must take precedence for our attention and action.”
She added, “This commission’s work is both a starting point and a call to action to mobilise and energise healthcare professionals, policymakers – and women themselves – to work towards a healthier future.”
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