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Abstract
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While violence against women has existed throughout human history, there is a growing recognition that this global crisis not only undermines the dignity, safety, and human rights of women but is also a major public health threat. Similarly, cardiovascular disease (CVD) has been recognized as one of the most important public health issues, accounting for one third of all deaths in women.1 Growing evidence, including the work by Chandan et al2 in the current issue of the Journal of the American Heart Association (JAHA) suggests that intimate partner violence (IPV) might increase the risk of CVD. While disparities that disfavor women persist with respect to CVD diagnosis, risk stratification, management, and outcomes, recognizing nontraditional CVD risk factors is an important opportunity to improve healthcare quality in women. Furthermore, the identification of IPV, a major global health threat affecting >30% of women,3 as a risk factor for CVD has widespread implications with potential to impact healthcare delivery and public policy.
IPV is defined as physical or sexual violence, emotional abuse, and stalking. In the United States, >30% of women have experienced contact physical or sexual IPV; 25% of women have experienced IPV severe enough that it resulted in injury, the need for medical care, or posttraumatic stress symptoms.4 Approximately one third of men also experience IPV, although at a lower severity than women (ie, less often associated with injury/need for medical care).5 Although IPV typically begins early in life, with its occurrence highest among adolescent and young‐adult women,6 it impacts women of all ages. Globally, IPV is the leading cause of homicide death for women.7 IPV has a well‐documented adverse impact on mental and physical health in women. Women who have experienced IPV are at increased risk of multiple mental health conditions (eg, depression, anxiety, eating disorders, posttraumatic stress disorder, and substance abuse) as well as physical health (eg, chronic pain, gastrointestinal problems, sexually transmitted infections, traumatic brain injury).8, 9 IPV victimization is linked to CVD risk factors such as diabetes mellitus and hypertension in women10, 11 and possibly also in men when severe and/or when he is also the perpetrator of violence.12, 13 Furthermore, as demonstrated in the publication by Chandan et al,2 IPV in women may also be associated with clinical CVD.
CVD is the leading cause of death in women worldwide. In the United States, CVD accounted for 299,578 deaths in women in 2017, about 1 in every 5 female deaths.14 Although CVD mortality in women has declined over the past 30 years, this decline has recently plateaued, with an alarming increase in CVD mortality in women under age 55 years.15 Furthermore, CVD is the second highest cause of disability‐adjusted life years lost in women around the globe.16 Significant healthcare disparities and gaps persist in the care and outcomes of women. Women are less likely to receive an early diagnosis of CVD than their male counterparts and less likely to receive appropriate, timely interventions.1, 17 Women have worse outcomes than men after acute coronary syndromes such as higher mortality rates in younger women and higher postintervention complications ...
Language: en |