Gender differences explored: Cardiovascular health variances in women's lifespan

Women's cardiovascular disease risks and outcomes differ throughout the lifespan from those of men, according to a collection of studies devoted to cardiovascular medicine research focused on women of all ages, published today in a special "spotlight" issue of the Journal of the American Heart Association, an open access, peer-reviewed journal of the American Heart Association.

Cardiovascular disease kills more women than all forms of cancer combined. Among females 20 years and older, nearly 45% are living with some form of cardiovascular disease, and less than 50% of women entering pregnancy in the U.S. have good heart health. In addition, more than half of deaths from high blood pressure are in women. Yet, women make up only 38% of participants in cardiovascular disease clinical trials, according to the American Heart Association.

The special Go Red for Women issue of the Journal, in recognition of American Heart Month, features studies that reveal insights such as: how diet may affect the high preeclampsia risk in pregnant Hispanic/Latina women; how women were less likely than men to receive bystander CPR and automated external defibrillator (AED) treatment, as well as survive the first 30 days post-hospitalization after out-of-hospital cardiac arrest; and how rehospitalization rates differ in women with heart failure and obstructive sleep apnea. In yet another study featured, researchers report that while the incidence of intracerebral hemorrhage (bleeding within the brain), the second most common stroke type, was lower in women, women were more likely to die one year after a stroke than men.

Below are highlights of some of the manuscripts in this issue,

• Prospective Associations of Accelerometer-measured Machine-learned Sedentary Behavior with Mortality among Older Women: The OPACH Study

Steve Nguyen, Ph.D., et al.; University of California, San Diego, La Jolla, California

This team studied sedentary behavior patterns in nearly 6,000 older women (average age 79 years) to determine the impact of sitting time on death from cardiovascular disease and all causes. Using a measurement tool powered by machine learning to accurately classify sitting time, researchers found those who sat more than 11.6 total hours a day and had longer bouts of uninterrupted sitting had a 57% higher risk of death from all causes and a 78% increased risk of death from cardiovascular disease. This was compared to women who sat less than 9.3 hours a day. The increased risk of death was consistent regardless of age, body mass index, physical functioning, cardiovascular disease risk factors, physical activity intensity and race/ethnicity. Reducing overall sedentary behavior and uninterrupted sitting time would likely have large public health benefits in an aging society, according to researchers.

• Sex Differences in the Relationship between Schizophrenia and the Development of Cardiovascular Disease

Hidehiro Kaneko, M.D., Ph.D., et al.; University of Tokyo, Tokyo, Japan

Researchers studied cardiovascular disease risk in people with schizophrenia, a serious psychotic disorder and one of the top 15 leading causes of disability worldwide. Schizophrenia results in severe, chronic mental illness characterized by disturbances in perception, thought and behavior. The study found a strong association between schizophrenia and risk of developing cardiovascular disease in adults, but particularly in women. This higher risk in women may be related to hormonal changes during pregnancy and menopause, or reports that women are more sedentary than men. Nevertheless, the findings point to the need for health care professionals to take a thorough and gender-focused approach to cardiovascular disease prevention due to the notable role schizophrenia seems to play in cardiovascular disease. The researchers suggest that it's crucial to promote physical activity, especially among women with schizophrenia, as inactivity may have increased the risk in female participants in this study. Healthcare providers should routinely screen and treat schizophrenia as part of standard clinical practice, with special attention to women, authors wrote.

• Maternal Dietary Patterns During Pregnancy Are Linked to Hypertensive Disorders of Pregnancy Among a Predominantly Low-Income US Hispanic/Latina Pregnancy Cohort

Luis E. Maldonado, Ph.D., M.P.H., et al.; Keck School of Medicine, University of Southern California

In a study of more than 400 predominantly low-income, pregnant Hispanic/Latina women in Los Angeles, researchers found that a diet characterized by higher intakes of solid fats, refined grains and cheese was strongly associated with greater odds of having had a hypertensive disorder of pregnancy including preeclampsia during pregnancy.

Other papers in the spotlight issue include:

• Association of Sex With Cardiovascular Outcomes in Heart Failure Patients With Obstructive or Central Sleep Apnea -; Jian Zhang, M.D., Ph.D., et al.; Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
• Pregnancy History at 40 Years of Age as a Marker of Cardiovascular Risk -; Liv G. Kvalvik, M.D., Ph.D., et al.; University of Bergen, Bergen, Norway
• Sex Differences in the Epidemiology of Intracerebral Hemorrhage Over 10 Years in a Population-Based Stroke Registry -; Simona Sacco, M.D., et al.; University of L'Aquila, L'Aquila, Italy
• Sex Differences in Revascularization, Treatment Goals, and Outcomes of Patients With Chronic Coronary Disease: Insights From the ISCHEMIA Trial -; Harmony R. Reynolds, M.D., FAHA, et al.; NYU Grossman School of Medicine, New York City
• Sex Differences in Receipt of Bystander CPR Considering Neighborhood Racial and Ethnic Composition -; Audrey L. Blewer, Ph.D., M.P.H., et al.; Duke University, Durham, North Carolina
• Hypertension in Pregnancy among Immigrant and Swedish Women – A Cohort Study of All Pregnant Women in Sweden -; Axel C. Carlsson, Ph.D., et al.; Karolinska Institutet, Huddinge, Sweden
• Sex Differences In Out-of-Hospital Cardiac Arrest Survival Trends -; R. L. A. Smits, et al.; Amsterdam University Medical Center, Amsterdam, The Netherlands;
• Posttraumatic Stress Disorder is Associated With Elevated Risk of Incident Stroke and Transient Ischemic Attack in Women Veterans -; Ramin Ebrahimi, M.D., et al.; University of California, Los Angeles; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles; and
• Sex differences in Outcomes of Acute Myocardial Injury After Stroke -; Michela Rosso, M.D., et al.; University of Pennsylvania, Philadelphia.