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Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity: A Scientific Statement From the American Heart Association

Mehta LS, Velarde GP, Lewey J, Sharma G, Bond RM, Navas-Acien A, Fretts AM, Magwood GS, Yang E, Blumenthal RS, Brown RM, Mieres JH, American Heart Association Cardiovascular Disease and Stroke in Women and Underrepresented Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Hypertension, Council on Lifelong Congenital Heart Disease and Heart Health in the Young, Council on Lifestyle and Cardiometabolic Health, Council on Peripheral Vascular Disease, Stroke Council

Published May 9, 2023 Circulation, 147(19), 1471-1487
DOI 10.1161/CIR.0000000000001139 PMID 37035919 PMC PMC11196122

RRM Academy Synopsis

Cardiovascular disease risk differs by race and ethnicity in US women

Cardiovascular disease risk differs among US women by race and ethnicity. It is the leading cause of death in US women. An American Heart Association group reviewed studies of four groups of women. Language barriers and discrimination fall more heavily on these women. Current risk models leave out pregnancy complications and age at menopause.

Study at a glance, literature review of four groups of women: Cardiovascular risk differs by race and ethnicity in US women
Study at a glance, literature review of four groups of women: Cardiovascular risk differs by race and ethnicity in US women. Source: Mehta LS et al., 2023, PMID 37035919.

Key Findings

  • Among non-Hispanic Black women aged 20 and older, nearly 60% have cardiovascular disease. Life expectancy averages 75 years for these women and 80 years for non-Hispanic White women.
  • Hispanic/Latina women have cardiovascular death rates 15% to 20% lower than non-Hispanic White women despite more diabetes, obesity, and metabolic syndrome, a pattern that may not apply equally across subgroups.
  • Among American Indian and Alaska Native people, more than one-third of cardiovascular deaths occur before age 65, and almost 50% of adult women have at least 2 cardiovascular risk factors.
  • Current risk models omit sex-specific factors such as preeclampsia and age at menopause, and the default White equation applied to other racial and ethnic groups may not predict risk accurately.
  • The statement calls for equitable access to preventive care and names peer-led, culturally sensitive education a necessary step in prevention. It says guidelines are not equally incorporated into practice.

Interpretation

The statement is a literature review by a writing group of the American Heart Association. The group searched studies in English, mainly in PubMed. It reviews racial and ethnic differences in risk factors and prevention for women in the United States. The four groups are non-Hispanic Black, Hispanic and Latina, American Indian and Alaska Native, and Asian women. The statement views race and ethnicity mainly as social and demographic constructs. In the figures for Black and Hispanic women, cardiovascular disease includes high blood pressure and stroke. The authors note gaps in what is known and in the data for each race and ethnicity.

RRM Context

RRM views reproductive history as a sign of overall health. The statement also names miscarriage and the timing of menarche as sex-specific factors that risk models omit. Cycle charting builds a record of cycle length and fertility signs over many years. RRM counts that record and pregnancy history as clinical information.

Our editorial summary of this paper, not the article's abstract.

Abstract

Cardiovascular disease is the leading cause of death in women, yet differences exist among certain racial and ethnic groups. Aside from traditional risk factors, behavioral and environmental factors and social determinants of health affect cardiovascular health and risk in women. Language barriers, discrimination, acculturation, and health care access disproportionately affect women of underrepresented races and ethnicities. These factors result in a higher prevalence of cardiovascular disease and significant challenges in the diagnosis and treatment of cardiovascular conditions. Culturally sensitive, peer-led community and health care professional education is a necessary step in the prevention of cardiovascular disease. Equitable access to evidence-based cardiovascular preventive health care should be available for all women regardless of race and ethnicity; however, these guidelines are not equally incorporated into clinical practice. This scientific statement reviews the current evidence on racial and ethnic differences in cardiovascular risk factors and current cardiovascular preventive therapies for women in the United States.

By this author

Related research

Laxmi S Mehta, Gladys P Velarde, Jennifer Lewey, Garima Sharma, Rachel M Bond, Ana Navas-Acien, Amanda M Fretts, Gayenell S Magwood, Eugene Yang, Roger S Blumenthal, Rachel-Maria Brown, Jennifer H Mieres
L Mehta, G Velarde, Jen Lewey, Jenny Lewey, J Lewey, G Sharma, R Bond, A Navas-Acien, A Fretts, G Magwood, E Yang, R Blumenthal, R Brown, Jen Mieres, Jenny Mieres, J Mieres
PMID 37035919 37035919 DOI 10.1161/CIR.0000000000001139 10.1161/CIR.0000000000001139 Mehta et al. 2023, Mehta 2023

Keywords

AHA Scientific Statements, cardiovascular diseases, ethnicity, primary prevention, racial groups, risk factors, women

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