Actionable points on disease conditions contributing to CVD
| Disease condition | Actionable points |
| Traditional CV risk factors |
⇒ Raise awareness of the suboptimal control of some of the traditional CV risk factors in women to proactively identify any untreated risk factor in the early stage. ⇒ Promote awareness campaigns among premenopausal women to proactively seek support to address modifiable CV risk factors. |
| Women-specific risk factors |
⇒ Raise awareness among public and clinicians about the link between female-specific risk factors and CVD. ⇒ Determine how to integrate reproductive life course events into personalised CV care to improve risk prediction for women. ⇒ Investigation of specific subsets such as pregnant, pre- or post-menopausal women through dedicated study protocols in collaboration with other specialties such as obstetrics and/or gynaecologists. |
| Coronary artery disease |
⇒ Increase awareness among public and clinicians that CAD is the leading cause of mortality for women. ⇒ Avoid delays in access to care in the setting of ACS. ⇒ Provide a complete diagnostic work-up in case of non-obstructive coronary arteries (MINOCA, ANOCA, INOCA which occur more frequently in women) to investigate the underlying mechanism and direct medical therapy. ⇒ Proactively enrol female patients with CAD in research studies and undertake women-only studies. |
| Valvular heart disease |
⇒ Raise awareness among clinicians and patients of the sex differences in valve and ventricular parameters in the context of valvular heart disease. ⇒ Proactively enrol female patients in heart valve disease research studies. ⇒ Ensure women have timely access to investigations including echocardiography and valve interventions. ⇒ Identify and address barriers to appropriate referral for valve interventions. ⇒ Device-specific considerations to ensure appropriate intervention to reduce prosthesis mismatch and complications in women. |
| Heart failure |
⇒ Raise awareness that women with HFrEF are less likely to receive GDMT, referral for ICD, CRTD and heart transplant compared with men. ⇒ Ensure women receive GDMT and access to device therapy. ⇒ Undertake research to identify optimal dosing of GDMT for women. ⇒ Ensure representation of women in HF research studies. |
| Inherited cardiac conditions |
⇒ Identify sex-specific thresholds for diagnosis of DCM and HCM. ⇒ Conduct detailed research to address modifiable sex differences in outcomes for ICCs in women. ⇒ Ensure equitable access to specialist cardiac care, genetic testing and family screening. ⇒ Define and ensure training in ICCs which include understanding sex differences and disparities in ICCs. ⇒ Address workforce challenges in ICCs. |
| Adult congenital heart defects |
⇒ Prioritisation of research in this area leading to future sex-specific interventions, treatment and care models. ⇒ Audited sex-specific outcome data in ACHD. ⇒ Harmonisation and standardisation of exposure to and training in ACHD Cardiology and Cardiac Obstetrics/Maternal medicine which include understanding sex differences and disparities in ACHD. ⇒ Address the workforce challenges in ACHD to optimise sex-specific personalised prevention, disease identification, prognosis definition and individualised therapeutic strategies. |
| Heart rhythm disorders |
⇒ Despite the primarily female demographic of postural orthostatic tachycardia syndrome and dysautonomia syndromes, the evidence base is poor and requires significant research and collaborative efforts. ⇒ Further investment in addressing inequalities of arrhythmia management in women requires a multifaceted approach, including promoting sex- and gender-based analysis in research and expanding the use of quality improvement programme. |
ACHD, adult congenital heart defects; ACS, acute coronary syndrome; ANOCA, angina with non-obstructive coronary arteries; CAD, coronary artery disease; CRTD, cardiac resynchronisation therapy with defibrillator; CV, cardiovascular; CVD, cardiovascular disease; DCM, dilated cardiomyopathy; GDMT, guideline-directed medical therapy; HCM, hypertrophic cardiomyopathy; HF, heart failure; HFrEF, heart failure with reduced ejection fraction; ICCs, inherited cardiac conditions; ICD, implantable cardiac defibrillator; INOCA, ischaemia with non-obstructive coronary arteries; MINOCA, myocardial infarction with non-obstructive coronary arteries.