The Canadian Women’s Heart Health Alliance Atlas on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women — Chapter 4: Sex- and Gender-Unique Disparities: CVD Across the Lifespan of a Woman
Sharon L. Mulvagh, MD, FRCPC, FACC, FASE, FAHA,
Kerri-Anne Mullen, PhD, MSc,
Kara A. Nerenberg, MD, MSc,
Amy A. Kirkham, PhD, P.Kin, ATTH,
Courtney R. Green, PhD, MSc,
Abida R. Dhukai, NP(Adult), MN, PhD(c),
Jasmine Grewal, MD, FRCPC,
Marsha Hardy, MSW, RSW,
Paula J. Harvey, BMBS, PhD, FRACP,
Sofia B. Ahmed, MD, MMSc, FRCPC,
Donna Hart, BA, RSW,
Anna L.E. Levinsson, PhD,
Monica Parry, MEd, MSc, NP-Adult, PhD, CCN(C),
Heather J.A. Foulds, PhD,
Christine Pacheco, MD, MSc, FRCPC,
Sandra M. Dumanski, MD, FRCPC,
Graeme Smith, MD, PhD, FRCSC,
Colleen M. Norris, PhD, MSc, BScN, FAHA, FCAHS
Affiliations
Sharon L. Mulvagh, MD, FRCPC, FACC, FASE, FAHA
Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA; Corresponding author: Dr Sharon L. Mulvagh, 1796 Summer St, Room 2148.5, Halifax, Nova Scotia B3H 3A7, Canada. Tel.: +1-902-473-7383; fax: 902-473-2434.
Kerri-Anne Mullen, PhD, MSc
Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
Kara A. Nerenberg, MD, MSc
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Amy A. Kirkham, PhD, P.Kin, ATTH
Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
Courtney R. Green, PhD, MSc
The Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
Abida R. Dhukai, NP(Adult), MN, PhD(c)
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Jasmine Grewal, MD, FRCPC
Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
Marsha Hardy, MSW, RSW
Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
Paula J. Harvey, BMBS, PhD, FRACP
Women’s College Research Institute and Division of Cardiology, Department of Medicine, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
Sofia B. Ahmed, MD, MMSc, FRCPC
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Donna Hart, BA, RSW
Canadian Women’s Heart Health Alliance, Ottawa, Ontario, Canada
Anna L.E. Levinsson, PhD
Montréal Heart Institute; Beaulieu-Saucier Université de Montréal Pharmacogenomics Centre; Faculty of Medicine, Université de Montréal, Montréal, Quebec, Canada
Monica Parry, MEd, MSc, NP-Adult, PhD, CCN(C)
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
Heather J.A. Foulds, PhD
College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
Christine Pacheco, MD, MSc, FRCPC
Hôpital Pierre-Boucher, Centre Hospitalier de l’Université de Montréal (CHUM), Université de Montréal, Montreal, Québec, Canada
Sandra M. Dumanski, MD, FRCPC
Department of Medicine, University of Calgary, Calgary, Alberta, Canada
Graeme Smith, MD, PhD, FRCSC
Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
Colleen M. Norris, PhD, MSc, BScN, FAHA, FCAHS
Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
Women have unique sex- and gender-related risk factors for cardiovascular disease (CVD) that can present or evolve over their lifespan. Pregnancy-associated conditions, polycystic ovarian syndrome, and menopause can increase a woman’s risk of CVD. Women are at greater risk for autoimmune rheumatic disorders, which play a role in the predisposition and pathogenesis of CVD. The influence of traditional CVD risk factors (eg, smoking, hypertension, diabetes, obesity, physical inactivity, depression, anxiety, and family history) is greater in women than men. Finally, there are sex differences in the response to treatments for CVD risk and comorbid disease processes. In this Atlas chapter we review sex- and gender-unique CVD risk factors that can occur across a woman’s lifespan, with the aim to reduce knowledge gaps and guide the development of optimal strategies for awareness and treatment. Résumé: Les femmes présentent des facteurs de risque de maladies cardiovasculaires (MCV) uniques, liés au sexe et au genre, qui peuvent se manifester ou évoluer tout au long de leur vie. Les troubles médicaux associés à la grossesse, le syndrome des ovaires polykystiques et la ménopause peuvent augmenter le risque de MCV chez une femme. Les femmes sont plus exposées aux troubles rhumatologiques auto-immuns, qui jouent un rôle dans la prédisposition et dans la pathogenèse des MCV. L’influence des facteurs de risque traditionnels pour les MCV (par exemple, le tabagisme, l’hypertension, le diabète, l’obésité, la sédentarité, la dépression, l’anxiété et les antécédents familiaux) est plus importante chez les femmes que chez les hommes. Enfin, il existe des différences entre les sexes dans la réponse aux traitements du risque de MCV et des processus pathologiques comorbides. Dans ce chapitre de l’Atlas, nous passons en revue les facteurs de risque de MCV propres au sexe et au genre qui peuvent survenir tout au long de la vie d’une femme, dans le but de réduire les lacunes dans les connaissances et d’orienter l’élaboration de stratégies optimales de sensibilisation et de traitement.
