The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women - Chapter 7: Sex, Gender, and the Social Determinants of Health

Women vs men have major differences in terms of risk-factor profiles, social and environmental factors, clinical presentation, diagnosis, and treatment of cardiovascular disease. Women are more likely than men to experience health issues that are complex and multifactorial, often relating to disparities in access to care, risk-factor prevalence, sex-based biological differences, gender-related factors, and sociocultural factors. Furthermore, awareness of the intersectional nature and relationship of sociocultural determinants of health, including sex and gender factors, that influence access to care and health outcomes for women with cardiovascular disease remains elusive. This review summarizes literature that reports on under-recognized sex- and gender-related risk factors that intersect with psychosocial, economic, and cultural factors in the diagnosis, treatment, and outcomes of women's cardiovascular health.

The Canadian Women's Heart Health Alliance ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women-Chapter 2: Scope of the Problem

Background

This Atlas chapter summarizes the epidemiology of cardiovascular disease (CVD) in women in Canada, discusses sex and gender disparities, and examines the intersectionality between sex and other factors that play a prominent role in CVD outcomes in women, including gender, indigenous identity, ethnic variation, disability, and socioeconomic status.

Methods

CVD is the leading cause of premature death in Canadian women. Coronary artery disease, including myocardial infarction, and followed by stroke, accounts for the majority of CVD-related deaths in Canadian women. The majority of emergency department visits and hospitalizations by women are due to coronary artery disease, heart failure, and stroke. The effect of traditional cardiovascular risk factors and their association with increasing cardiovascular morbidity is unique in this group.

Results

Indigenous women in Canada experience increased CVD, linked to colonization and subsequent social, economic, and political challenges. Women from particular racial and ethnic backgrounds (ie, South Asian, Afro-Caribbean, Hispanic, and Chinese North American women) have greater CVD risk factors, and CVD risk in East Asian women increases with duration of stay in Canada.

Conclusions

Canadians living in northern, rural, remote, and on-reserve residences experience greater CVD morbidity, mortality, and risk factors. An increase in CVD risk among Canadian women has been linked with a background of lower socioeconomic status, and women with disabilities have an increased risk of adverse cardiac events.

A critical discourse analysis of gendered cardiovascular disease meanings of the #MoreMoments campaign on Twitter

The purpose of this study was to explore how the Heart and Stroke Foundation of Canada and Canadian Twitter users linked women's experiences and health identities with the #MoreMoments cardiovascular disease awareness campaign. Critical discourse analysis of Twitter data between September 2017 and November 2017 identified two primary discourses (tragedy and loss, and life and health) and two identity/subject positions (visionary leaders and successful survivors). Responsibility for women's health was attributed to the Heart and Stroke Foundation of Canada, also limiting neo-liberal healthism and risk identification. Novel findings included resistance through use of 'small stories' within discourses regarding the targeted demographic for health promotion and knowledge translation.

Constructing women’s heart health and risk: A critical discourse analysis of cardiovascular disease portrayals on Facebook by a US non-profit organization

Women’s cardiovascular disease portrayals were explored on Facebook by the US non-profit organization Women’s Heart Alliance and public users in February 2017. Portrayals were explored using critical discourse analysis which also identified subject positions. Women’s cardiovascular disease was constructed within two central discourses: achieving health equity and healthism, with the following subject positions: altruistic fighters, health activists, and compliant patients and consumers. These findings affirmed and resisted problematic forms of cardiovascular disease risk reduction. Recommendations are made using discursive resources and subject positions within social media forms as concrete entry points of resistance and change to raise women’s cardiovascular disease awareness.

Social media for health promotion: What messages are women receiving about cardiovascular disease risk by the Canadian Heart and Stroke Foundation?

The aim of this study was to explore the meanings of women's cardiovascular disease constructed within the Canadian Heart and Stroke Foundation Facebook page. Posts from Heart and Stroke Foundation and public user comments surrounding the launch of the Heart and Stroke Foundation re-branding were of interest. Ethnographic content analysis was employed to analyse text (n = 40), images (n = 32), videos (n = 6), user comments and replies (n = 42) from November 2016 to March 2017. Constructions (re)presented on Facebook of 'typical' women at risk and risk reduction were problematic as women most at risk were excluded through the use of consumerist, medicalized identities which also excluded promotion of healthy behaviour changes.

Social media for health promotion: What messages are women receiving about cardiovascular disease risk by the Canadian Heart and Stroke Foundation?

The aim of this study was to explore the meanings of women's cardiovascular disease constructed within the Canadian Heart and Stroke Foundation Facebook page. Posts from Heart and Stroke Foundation and public user comments surrounding the launch of the Heart and Stroke Foundation re-branding were of interest. Ethnographic content analysis was employed to analyse text (n = 40), images (n = 32), videos (n = 6), user comments and replies (n = 42) from November 2016 to March 2017. Constructions (re)presented on Facebook of 'typical' women at risk and risk reduction were problematic as women most at risk were excluded through the use of consumerist, medicalized identities which also excluded promotion of healthy behaviour changes.