Effect of lifestyle and non-traditional cardiovascular risk factors on cardiovascular disease in women

Abstract

Sex disparities persist in the screening, prevention and management of cardiovascular disease (CVD) on a global scale. Yet, there is limited research into lifestyle and female-specific risk factors, such as past pregnancy complications and premature/early menopause, on women's cardiovascular health. A narrative review revealed that while studies have consistently favoured the Mediterranean diet (MD), the effect of a MD in female-specific populations was unclear. Our meta-analysis of >700,000 women found that higher MD adherence conferred a 24% lower risk for incident CVD and 23% lower risk for total mortality. A retrospective analysis of a middle-aged female cohort found that the highest versus lowest intake of ultra-processed foods was associated with 39% higher odds for incident hypertension, but not CVD. Another retrospective analysis found that women with premature and early menopause had higher odds for CVD by 36% and 15% respectively and lifestyle modification reduced this risk in all women by 23%. A prospective six-month Women Heart’s Clinic (WHC) intervention of women with past pregnancy complications found 24-hour ambulatory blood pressure (BP) monitoring detected incident hypertension in more than 60% and after the WHC, three-quarters of these women improved their BP control. The WHC study also revealed that only 19% of women were aware their CVD risk at baseline and over 75% improved their awareness after six-months. An open-labelled 1:1 randomised texting intervention did not significantly improve healthy lifestyles in either sexes over 12-weeks, but acceptability of the lifestyle-focused program was high. This thesis found that women with female-specific risk factors have increased CVD risk, yet majority are unaware of this risk. Lifestyle modification, particularly diet, and CVD risk screening are two key pillars of CVD prevention in high-risk women. Future studies should consider sex-specific interventions to redesign preventative CVD care for women.