Women’s Health Dashboard:
Ischemic Heart Disease

Ischemic heart disease (IHD) refers to the reduced blood flow and oxygen supply to the heart, usually caused by plaque buildup in the arteries surrounding the heart. Lack of oxygen and other key nutrients may ultimately lead to a myocardial infarction (or heart attack). IHD is also known as coronary heart disease or coronary artery disease.

For women and men alike, risk factors for the developing IHD include older age, obesity, dyslipidemia, diabetes, hypertension, inactivity, family history of IHD, and smoking [1]. However, research has shown that there are significant sex differences in the pathophysiology, symptom presentation, efficacy of diagnostic tests and pharmacological therapies, and clinical outcomes for IHD [1]. For example, 50% of women diagnosed with IHD do not have atherosclerotic obstruction of the arteries, which is the classical presentation in men [2].

The information presented below has been curated from 2018 data, unless otherwise stated. 

Disease Burden

In 2018, 7.7% of males and 4.6% of females in the United States were living with IHD [3]. That same year, IHD was the leading cause of death for both women and men, despite there being a 28% decline in the annual death rate attributable to IHD between 2008-2018 [4].

IHD prevalence rates are consistently higher for American Indian and Alaska Native populations compared to other racial/ethnic groups, yet researchers believe these rates are still underreported by up to 20% [5].

Total direct and indirect costs attributable to IHD were estimated to reach $208 billion in 2018 [3]. Medical costs, including hospital, physician, prescription, and home health services comprised $102 billion, while forgone earnings, household productivity, and premature mortality due to IHD were valued at $106.4 billion [3].

Disease Prevalence and Mortality

Ischemic Heart Disease Prevalence* by Sex

*Age-adjusted among individuals 18 years and older
Source: Lee Y-TH, et al. (2022) [3]

Ischemic Heart Disease Prevalence by Age

Source: Lee Y-TH, et al. (2022) [3]

Ischemic Heart Disease Prevalence* by Race

*Age-adjusted among individuals 18 years and older
Source: Lee Y-TH, et al. (2022) [3]

Download Ischemic Heart Disease Prevalence Data (2018)

 

Source: CDC Wonder [6]

Ischemic Heart Disease Mortality, U.S. Females, All Ages – Top 5 States

Crude Rates are expressed as the number of deaths reported for a calendar year per 100,000 persons.
Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
N/A: Number of deaths fall below a determined cut-off value and therefore are suppressed, and a crude rate is not calculated.
Unreliable: Death rates are flagged as unreliable when the rate is calculated with a numerator of 20 or fewer deaths.
*Includes Hispanic individuals of any race

Ischemic Heart Disease Mortality, U.S. Females, All Ages, by Race – Top 3 States

Black/AA: Black or African American; Hispanic: Hispanic or Latino; API: Asian or Pacific Islander; AI/AN: American Indian or Alaska Native
*Includes Hispanic individuals of any race

Among the states with the highest IHD mortality, rates for white and Black or African American women were the highest compared to all other racial groups. New York was among the top 3 states for IHD mortality for all racial groups except for American Indian and Alaska Native populations. Although much smaller in size compared to other states, the District of Columbia had one of the highest mortality rates for Black or African American women.

Download the Full Data Table of Ischemic Heart Disease Mortality (2018), U.S. Females, All Ages, by Race and State

Disease Impacts and Influences

Multiple factors contribute to incidence, morbidity, and mortality for ischemic heart disease and its disproportional impact on women and women’s health, including but not limited to biological sex, sociocultural influences, and insurance coverage.

Research Investment

The National Institutes of Health funded $444 million in Heart Disease – Coronary Heart Disease research in 2018 (1.7% of its total budget). Of the 835 research grants funded, 14 (1.7%) projects focused on women’s health.*

*Women’s health focus was determined by searching the following key terms – Female, Gender, Maternal, Sex, and variations of Lactating, Pregnant, Women – in the project titles of all Heart Disease – Coronary Heart Disease funded grants, according to the NIH Research, Condition, and Disease Categorization (RCDC) report.

Download the Full List of 2018 NIH-Funded Grants for Coronary Heart Disease

Health Disparities

  • Women with diabetes have a 6x higher risk of mortality due to IHD than women without diabetes [7].
  • Gestational diabetes, which is unique to those who are pregnant, has been associated with increased risk (1.5x) of developing IHD [7].
  • Women are more likely than men to be diagnosed with IHD at older ages (usually after menopause) [7].
  • On average, women experience their first heart attack 10 years later than men [7].
  • Experts agree that cardiac rehabilitation is beneficial for all IHD patients in reducing cardiovascular risk factors after the occurrence of a cardiac event. Yet, women have a significantly lower referral rate by healthcare providers for this intervention compared to men (31.1% vs 42.2%, respectively), with the lowest rates among minority women [1].

Disease Burden

According to the World Health Organization Global Health Estimates, in 2018, ischemic heart disease accounted for 3,161,159 total disability-adjusted life years (DALY) lost among women 15 years and older. The highest DALY rate was among women 65 years and older – 46,520 per 100,000 persons [8].

Insurance Coverage

There are significant financial costs associated with medical care for individuals with chronic diseases such as IHD. Health insurance access and coverage are important for assisting with the financial burden. Below is a table displaying rates of insurance coverage for the states with the highest mortality rates attributed to IHD in 2018.

U.S. Health Insurance Coverage by State

Source: Kaiser Family Foundation Health Insurance Coverage of the Total Population (CPS), 2018 [9]
Uninsured: Includes individuals without health insurance and individuals who have coverage under the Indian Health Service only.
Employer: Includes individuals covered by employer-sponsored coverage either through their own job or as a dependent in the same household.
Non-Group: Includes individuals and families that purchased or are covered as a dependent by non-group insurance.
Medicaid: Includes individuals covered by Medicaid, the Children’s Health Insurance Program (CHIP), and those who have both Medicaid and another type of coverage, such as dual eligibles who are also covered by Medicare.
Medicare: Includes individuals covered by Medicare, Medicare Advantage, and those who have Medicare and another type of non-Medicaid coverage where Medicare is the primary payer. Excludes individuals with Medicare Part A coverage only and those covered by Medicare and Medicaid (dual eligibles).
Military: Includes individuals covered under the military or Veterans Administration.
N/A: Estimates with relative standard errors greater than 30% are not provided.

Download the Full Data Table of u.s. Health Insurance Coverage (2018), by State

Resources and References

Additional Resources

References

1McSweeney JC, Rosenfeld AG, Abel WM, et al. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science. Circulation, 2016 Mar 29;133(13):1302-1331.

2Garcia M, Mulvagh SL, Bairey Merz CN, et al. Cardiovascular Disease in Women. Circ Res, 2016 Apr 15;118(8):1273-1293.

3Lee Y-TH, Fang J, Schieb L, et al. Prevalence and Trends of Coronary Heart Disease in the United States, 2011 to 2018. JAMA Cardiol, 2022 Apr 1;7(4):459-462.

4Virani SS, Alonso A, Aparicio HJ, et al. Heart Disease and Stroke Statistics—2021 Update. Circulation, 2021 Feb 23;143(8):e254-e743.

5Breathett K, Sims M, Gross M, et al. Cardiovascular Health in American Indians and Alaska Natives: A Scientific Statement from the American Heart Association. Circulation, 2020 Jun 23;141(25):e948-e959.

6United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Underlying Cause of Death by Single Race 2018-2020 on CDC WONDER Online Database, released 2021. Data are compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Data for year 2018 are compiled from the Multiple Cause of Death File 2018, Series 20, No. 2X, 2020. Accessed at https://wonder.cdc.gov/controller/saved/D76/D282F136 Accessed 5 April 2022.

7Khandelwal A, Bakir M, Bezaire M, et al. Managing Ischemic Heart Disease in Women: Role of a Women’s Heart Center. Curr Atheroscler Rep, 2021 Aug 4;23(10):56.

8Global Health Estimates 2020: Disease burden by Cause, Age, Sex, by Country and by Region, 2000-2019. Geneva, World Health Organization; 2020.

9Kaiser Family Foundation State Health Facts. Health Insurance Coverage of the Total Population (CPS). Data Source: Census Bureau’s March Current Population Survey (CPS: Annual Social and Economic Supplements), 2017-2022. https://www.kff.org/other/state-indicator/health-insurance-coverage-of-the-total-population-cps/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 14 June 2022.

heart disease sheet

Call to Action

Despite the prevalence of heart disease and its history as the leading cause of mortality for women, there remain significant gaps in the research and understanding of ischemic heart disease (IHD) in women. In this resource, the Society for Women’s Health Research (SWHR) has identified priority areas to eliminate disparities in IHD among women, taking a lifespan approach that accounts for the experiences of women – from adolescence through menopause – and considers life events such as pregnancy.

View Call to Action

Check out some of SWHR’s work in Heart Health

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