Special Collection on Women's Heart Health
For American Heart Month 2015, the editorial team at Women’s Health Issues has assembled a special collection of research on women’s cardiovascular health published in the journal since mid-2011, following the release of updated American Heart Association guidelines on the prevention of cardiovascular disease in women. The articles address healthcare services for women at risk for cardiovascular disease; social determinants of health; and physical activity in specific populations of women.
These articles will be accessible for free during the month of February 2015 so that they are available to a wider interested audience.
Healthcare Services for Women's Heart Health
Several of the articles in the special collection address the healthcare services women receive for cardiovascular disease or the related risk factors of diabetes, gestational diabetes, high blood pressure, and high LDL cholesterol.
Studies involving groups of veterans with cardiovascular risk factors found higher LDL cholesterol levels among women veterans than their male counterparts (Goldstein et al, 2014; Vimalananda et al, 2011), and more women veterans with LDL values above 130 mg/dL (Sambamoorthi et al, 2012). One of these studies (Vimalananda et al, 2011) found that women veterans were less likely to be receiving lipid-lowering therapy than male veterans; another (Sambamoorthi et al, 2012) found that individual-level factors such as age, illness, and use of lipid-lowering medications could explain only one-third of the difference in LDL levels. Haskell and colleagues (2014) identified a combination of patient and provider factors that may be associated with poorer cholesterol control in women, with providers being less likely to order or adjust medications for women veterans, and women being more likely than men to refuse medications.
Studies not focusing on veterans identified additional factors associated with disparities in risk-factor control. In an analysis of data from the Reducing Racial Disparities in Diabetes with Coached Care study (Billimek et al, 2015), researchers found that women and men received comparable care for diabetes and lipid management, but more women than men reported non-adherence to lipid-lowering medication and gave side effects and cost as reasons. In a qualitative study (Ozminkowski et al, 2012) investigating reasons why many women with coronary artery disease do not receive annual office visits to manage this condition, researchers found skepticism among some women about their heart problems, more pressing health problems, and an absence of initiative to schedule appointments. The authors suggest improving communication and follow-up from providers to increase use of recommended care by women with coronary artery disease.
As the updated American Heart Association guidelines of 2011 noted, women who develop gestational diabetes mellitus (GDM) or preeclampsia during pregnancy are at elevated risk of cardiovascular disease later in life. A study of Medicaid-eligible women in South Carolina who had GDM (Hale et al, 2012) found that fewer than 4% received screening for diabetes after giving birth (5-13 weeks postpartum); the authors suggest that the expiration of Medicaid benefits 60 days after delivery for women covered due to pregnancy can exacerbate the challenge of providing appropriate screening and follow-up care to women with GDM. In another study, interviews with women from a single health system who had GDM but were not later tested for diabetes (Paez et al, 2014) identified the difficulty of fitting testing around work and caregiver demands as a barrier to screening, and also found some women perceiving their providers were not concerned about women's risk for diabetes following pregnancy. These authors suggest, "Consistent messages regarding long-term diabetes risk during pregnancy, access to postpartum primary care and convenient lab appointments, and systematic reminders to providers and patients are approaches that, in combination, may influence more resistant women to test."
In a 2012 Commentary, James M. Roberts and Janet M. Catov praise the American Heart Association's 2011 guideline update for including the recommendation that physicians obtain patients' pregnancy histories and consider preeclampsia and GDM as risk factors for later-in-life cardiovascular disease. They recommend additional research to identify appropriate next steps when patients tell their physicians they have had these conditions. After conducting focus groups with obstetrician/ gynecologist residents and practicing physicians, Ehrenthal and colleagues (2011) recommend establishment of evidence-based screening and referral recommendations for clinicians to help these providers play a greater role in cardiovascular disease prevention.
Findings from two other studies show progress toward improving provider education and reducing sex disparities in the care of those at risk for cardiovascular disease. An evaluation of the "Heart Truth" education campaign for healthcare providers (Ehrenthal et al, 2013) found that participants earned significantly higher knowledge scores following educational lectures. In a study of adults belonging to a not-for-profit HMO (Schroeder et al, 2014), researchers found that diabetic women and men had important differences in their control of hemoglobin A1c, blood pressure, and LDL cholesterol at the time of diabetes diagnosis, but that the differences decreased during the year following diagnosis.