Inaugural Go Red for Women Issue

Cardiovascular diseases are the leading cause of death among women, a fact widely recognized for years. Yet, the significance of heart disease in women has been underappreciated, and women are significantly underrepresented in cardiovascular clinical research. Women and men share common features in the manifestations and pathophysiology of heart and vascular disease, and understanding of those pathophysiological mechanisms is incomplete. At the same time, significant differences exist that have largely been neglected by regulatory, industrial, funding, and research policies.

In response to these unmet needs, the American Heart Association’s Go Red For Women was launched in 2004 to develop a strategic and integrated approach to the care of women with heart disease. In 2015, Nancy Brown, CEO of the American Heart Association, delineated the history of the Go Red for Women initiative, tracking its progression from an enterprise aimed largely at improving the awareness of cardiovascular disease in women to the development of risk assessment tools, management guidelines, and research focused on the influences of sex on all aspects of cardiovascular disease.¹

Thirteen years ago, when the Go Red for Women initiative was launched, the landscape was much different than it is today. Perhaps because women have been historically underrepresented in research studies, little was known about the differences in biomarker profiles between women and men. Cardiovascular professionals and patients were struggling with the lack of recognition of the importance of identifying cardiovascular risk factors and developing appropriate treatment plans for women with heart disease. Little was known about the impact of pregnancy and its complications on subsequent cardiovascular disease in the offspring and mother. Defining the social determinants of health and contrasting their differential impact on cardiovascular outcomes in women and men had not emerged as an important area of research. The role of implicit, gender-based bias in influencing our care of patients was not emphasized in the literature.

This inaugural Go Red for Women issue in Circulation is a new effort to address the menace of heart and vascular disease in women. The issue celebrates contemporary research developments that guide care provided to women with cardiovascular disorders. Indeed, we can all take pride in the broad spectrum of high-quality investigation that now addresses the unique determinants, presentations, and outcomes of heart disease in women. We include studies ranging from the influence of pregnancy on cardiovascular risk to a deeper understanding of variation in outcomes by sex after myocardial infarction. We include an in-depth review of arrhythmias in women.

At the same time, the issue highlights challenges that remain. For example, preclinical research in animal models still fails to fully grasp the complexities of sex in heart disease. Women still represent a minority of faculty reaching the rank of professor in academic medical centers, another challenge we explore.

We hope you enjoy this issue of Circulation and will apply its messages to the care and management of women with cardiovascular disease and to ongoing investigative initiatives. We pledge to continue to explore and promote pathbreaking cardiovascular research in both women and men, leading the way to a future free of these scourges.