The following are key points to remember about this American Heart Association (AHA) Presidential Advisory’s Call to Action for Cardiovascular Disease (CVD) in Women, which reviews epidemiology and prevention, awareness, access, and delivery of equitable health care:

1. CVD remains a leading cause of death for women in the United States. Under-representation of women in research remains a barrier to reducing knowledge gaps related to identifying, managing, and preventing CVD in women. This is particularly true for under-represented minority women. The AHA aims to improve health equity for CV care, including for women.
2. In addition to the failure to study CVD in both sexes, comparing women to men can lead to assumptions that what occurs in men is the gold standard. For example, the well-engrained (although erroneous) belief that women with myocardial infarction present more often with atypical symptoms carries an exculpatory undertone whereby women present the wrong way, not conforming to expectations. Thus, sex-specific data that characterize women without labeling symptoms as atypical could lead to different diagnostic and therapeutic choices.
3. Traditional CV risk factors are highly prevalent among US women. Furthermore, racial and ethnic differences exist, with rates of hypertension highest among non-Hispanic Black women, while low-density lipoprotein cholesterol is highest among non-Hispanic White women. Rates of diabetes are highest among Hispanic women, and rates of overweight and obesity are highest among non-Hispanic Black and Hispanic women. Rates of control for these risk factors are suboptimal.
4. The complex relationship between social determinants of health (SDOH) and CV health is currently not well understood. Adverse SDOH adversely affect the prevalence and progression of CVD across all ages, sex, and racial and ethnic groups. Further understanding of SDOH in relation to CV health among women is urgently needed.
5. The CV health of pre-gestational women in the United States has declined, and that of pregnant women is suboptimal and lower than among age-matched nonpregnant women. Risk factors for women include early menarche (<11 years of age), premature menopause (<40 years of age), polycystic ovarian syndrome, hypothalamic amenorrhea, hypertensive disorders of pregnancy, gestational diabetes, preterm delivery, low– or high–birth weight fetus, oral contraceptives, and hormone replacement.
6. Conditions that disproportionally affect women and are associated with an increased risk for CVD include systemic inflammatory and autoimmune disorders such as systemic lupus erythematosus, rheumatoid arthritis, and scleroderma. Depression and anxiety also carry an increased risk of CVD and are more frequent among women.
7. Prevention efforts are recommended to include increased awareness for health professionals regarding the impact of prevention on CVD risk factors as outcomes. Awareness campaigns should be culturally sensitive and appropriate with translations for the relevant audiences. Education must emphasize the wide-ranging benefits of prevention (80–90% of CVD is preventable) and lifetime CV health optimization.
8. Interdisciplinary collaboration between cardiologists, vascular neurologists, primary care clinicians, obstetricians, gynecologists, and other relevant health professionals is necessary to improve the recognition of women’s risk for CVD. In addition, risk calculators must integrate quantitative measures of risk in women for life course use (childhood and adolescent well visits, preconception, gestational and postpartum visits, and primary care and gynecologic visits).
9. Enhancing basic and translational research, which advances knowledge related to women’s CV health, is warranted. Ensuring that animal studies include female mice with a strategy and plan to assess and disseminate the outcomes of all studies is important. Attention and priority must be placed on ensuring that basic science and omic-related studies use and compare both female and male single cells, cell lines, stem cells, and organoids.
10. It is important to engage communities to optimize CV health across the life course, including school-based programs involving parents and empowering families and community-based programs including under-represented groups where they live and work. In addition, advocacy for public policy and legislative interventions must focus on SDOH, including healthy food access and food security, safe spaces for physical activity, clean indoor and outdoor air, and access to high-quality care for prevention and treatment.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Vascular Medicine, Lipid Metabolism, Nonstatins, Exercise, Hypertension

Keywords: Amenorrhea, Arthritis, Rheumatoid, Autoimmune Diseases, Cardiovascular Diseases, Cholesterol, LDL, Contraceptives, Oral, Depression, Diabetes, Gestational, Diabetes Mellitus, Ethnic Groups, Exercise, Female, Food Security, Health Equity, Hormones, Hypertension, Hypertension, Pregnancy-Induced, Lupus Erythematosus, Systemic, Menarche, Menopause, Myocardial Infarction, Obesity, Organoids, Overweight, Polycystic Ovary Syndrome, Pregnancy, Primary Prevention, Public Policy, Risk Factors, Social Determinants of Health, Translational Medical Research

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