Non-biological Factors, SDOH Play Key Role in Women’s CVD Risk Assessment

Non-biological factors and social determinants of health are important to include in cardiovascular disease (CVD) risk assessments for women, especially those who are form diverse races and ethnic backgrounds, according to a statement published by the American Heart Association (AHA) published in Circulation.

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“Risk assessment is the first step in preventing heart disease, yet there are many limitations to traditional risk factors and their ability to comprehensively estimate a woman’s risk for [CVD],” Jennifer Mieres, MD, FAHA, vice chair of the scientific statement writing committee and a professor of cardiology at the Zucker School of Medicine at Hofstra Northwell in Hempstead, New York, said in a statement.

The large data normally used to develop cardiovascular risk assessment formulas or algorithms are not racially and technically diverse, so they are not always representative of underrepresented groups, investigators said.

The AHA statement comes as a response to the presidential advisory as a review of evidence for CVD risk factors for ethnically and racially diverse women in the United States.

In addition to traditional risk factors, assessments for CVD risk should include those that are specific to females, including autoimmune disorders, depression, history of chemotherapy or radiation therapy, menstrual cycle history, polycystic ovarian syndrome, post-traumatic stress disorder, pregnancy-related conditions, and types of birth control.

The authors of the statement included the following factors:

1. Alaskan Native and indigenous women have higher of tobacco use than other groups. Additionally, type 2 diabetes (T2D) is the primary risk factor for heart disease among indigenous women, but it varied by region, with up to a 72% prevalence for those in Arizona and just over 40% for those in North Dakota, Oklahoma, and South Dakota. The authors added that understanding the risk of CVD for this group is a challenge, because of small sample sizes in national data and ethnic and/or racial misclassification.
2. Asian American women also have varied rates of CVD risk, with high blood pressure (HBP) rates at approximately 30% among Chinese individuals and 53% for Filipino individuals. For individuals who are Asian Indian and Filipino, the rates of low high-density lipoprotein cholesterol and high triglycerides are high, while T2D prevalence is highest among those who are Southeast Asian. The body mass index (BMI) levels for increased risk of T2D is lower for those who are Asian compared with other groups, and they are less likely to be obese or overweight. However, the authors said that they have higher rates of CVD, HBP, and T2D, adding that Asian individuals generally have a higher percentage of body fat than non-Hispanic white individuals, and Asian Indian, Chinese, and Filipino individuals have more abdominal fat than non-Hispanic Black and white individuals.
3. Hispanic women have a higher rate of obesity than Hispanic men. Women born in the United States also have higher rates of obesity than those born in other countries who immigrated to the United States. However, CVD death rates are approximately lower in Hispanic women than among non-Hispanic white women. The authors suggested that this could be because of research data grouping in various subcultures of Hispanic individuals.
4. Non-Hispanic Black women have the highest prevalence of HBP in the world and are the most likely to develop T2D. Additionally, they are more likely to be obese or extremely obese and to die of smoking-related diseases. Furthermore, they also are disproportionately affected by traditional risk factors and tend to experience CVD at younger ages.

Future CVD guidelines could be strengthened by culturally specific lifestyle recommendations based on cultural expectations and norms that influence attitudes, behavior, and beliefs related to diet, healthy weight, and physical activity.

The authors also called for more research to address these gaps in knowledge about risk factors among women, including data specific to subgroups for ethnicity and race.

Reference

Non-biological factors and social determinants of health important in women’s CVD risk assessment. News release. EurekAlert. April 10, 2023. Accessed April 12, 2023. https://www.eurekalert.org/news-releases/985273