Top Things to Know: CVD Risk Factors in Women: The Impact of Race and Ethnicity

Published: April 10, 2023

Prepared by Anne Leonard MPH, RN, FAHA – National Senior Director Science and Medicine

  1. Cardiovascular disease (CVD) remains the number one cause of mortality for women in the United States (US) and with this, focused research has helped clarify that has our understanding of sex-specific factors important in the detection of atherosclerosis and how we can reduce mortality related to CVD in women.
  2. This scientific statement considers not only those traditional risk factors but suggests social determinants of health (SDOH) and non-biological variables that impact CV risk and outcomes are essential for achieving American Heart Association (AHA) impact goals for advancing CV health and identifying and removing barriers to health care access and quality.
  3. The traditional CVD risk factors discussed in this statement for non-Hispanic Black, Hispanic/Latina (H/La), American Indian/Alaskan Native and Asian women include hypertension, dyslipidemia, diabetes mellitus, obesity, and tobacco with the current data available. Current limitations for using traditional risk factor screening tools in these populations are discussed.
  4. Mental health conditions are considered non-traditional risk factors and have a significant impact on CV health. These include depression related to hormonal changes, environmental, cultural stressors and psychosocial stressors of various levels are reviewed in this statement.
  5. SDOH (including economic stability, neighborhood safety, education social and community issues and access to quality health care) all play a role in the development of CVD and vary across race/ethnic groups.
  6. CVD is the leading cause of death for non-Hispanic Black women. Black in this context, is used as an umbrella term for a heterogenous population that often encompasses African American, African (East, West, South) & Caribbean. Several disparities in care are called out in this statement but noted within the paper as a key contributor to those disparities in care, is the disproportionate prevalence and magnitude of effect of traditional risk factors, most prominently driven by SDOH, which leads to this higher prevalence and earlier age of onset of CVD.
  7. CVD is the leading cause of mortality among H/La adults, the term which refers to individuals of any racial and ethnic background whose ancestry is from Mexico, Central America, South America, the Caribbean, or other Spanish speaking countries. In 2017, nearly 43% of H/La women had some form of CVD (CHD, HF, CVA, HTN).
  8. American Indian and Alaska Native people (AI/ANs) are a heterogeneous population that include 574 federally recognized tribes (and many tribes not federally recognized) and comprise approximately 2% of the US population. CVD (heart disease and CVA) is the leading cause of death in AI/AN women, and more than one third of CVD-related deaths occur among AI/AN men and women younger than 65 years of age. Our understanding the cardiovascular health of AI/ANs is challenging as many available national data sets underreport the burden of CVD and related mortality in AI/AN due to small sample sizes or racial misclassification, or both.
  9. CVD is the leading cause of mortality for Asian women in the US with the prevalence of CVD prevalence is high in non-Hispanic Asian women (45%). Federal Asian race/ethnicity classification is defined as people who have origins from the Far East, Southeast Asia, or the Indian subcontinent including countries such as Cambodia, China, India, Japan, Korea, Malaysia, Philippines, Thailand, and Vietnam.
  10. The race andethnic groups discussed in this paper are heterogenous and current research may leave us to extrapolate from racial and ethnic as generalizations rather than truer fact about the various groups. As an example there is a lack of Hispanic/Latina and AN/AI, and Asian-American representation in large registries used for CV risk assessment as evidenced in the ACC/AHA pooled cohort equation, specific risk calculators and not including SDOH within those equations. With this lack of data optimal management of CVD risk factors are hampered.
  11. This statement suggests that future CVD guidelines include culturally specific lifestyle recommendations that are tailored to the cultural norms and expectations that influence behaviors, beliefs, and attitudes regarding diet, physical activity, and health weight.
  12. CVD risk assessment in women is multifaceted, in that it surpasses the traditional risk factors to include sex-specific biological risk factors, incorporates race/ethnicity and non-biological factors, social determinants of health, behavioral, as well as environmental factors.
  13. Healthcare professionals need to be aware of these factors and translate the concepts within this statement into practice and use current guideline recommendations in clinical practice.

View the summary for Cardiovascular Disease Risk Factors in Women: The Impact of Race and Ethnicity

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Citation

Mehta LS, Velarde GP, Lewey J, Sharma G, Bond RM, Navas-Acien A, Fretts AM, Magwood GS, Yang E, Blumenthal RS, Brown R-M, Mieres JH; on behalf of the 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; and Stroke Council. Cardiovascular disease riskfactors in women: the impact of race and ethnicity: a scientific statement from the American Heart Association [published online ahead of print April 10, 2023]. Circulation. doi: 10.1161/CIR.0000000000001139

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