Cardiovascular disease risk reduction interventions for indigenous women: an umbrella review

Abstract

Cardiovascular disease (CVD) prevention strategies are predominantly informed by studies conducted in men from the general population, which can disadvantage women—particularly Indigenous women—whose CVD needs differ in terms of symptom presentation, healthcare access, receipt of guideline-recommended care and sociocultural roles. This review aims to summarize the effectiveness of CVD prevention interventions in Indigenous women in the USA, Canada, New Zealand and Australia. Umbrella review of systematic reviews and randomized and non-randomized interventions examines the effectiveness of pharmacological and nonpharmacological interventions in reducing CVD risk in target countries in Indigenous adult studies with ≥50% women. Systematic searches were conducted across six electronic databases between January and February 2024 (update: February 2025). Quality assessment applied standard methods and evidence was synthesized qualitatively. The protocol was PROSPERO registered (CRD42024575310). Six systematic reviews and 16 primary studies (7 randomized and 9 non-randomized; 11,473 participants; 50%–100% women) in Indigenous participants were included. Evidence was limited and generally of low certainty. Four randomized studies were exclusively in Indigenous women (Australia and USA). Only one pharmacological study was identified, investigating vitamin D in reducing blood pressure. Non-pharmacological interventions demonstrated potential to improve CVD risk factors, primarily adiposity, blood pressure, lipids, and glucose. Participant involvement was generally limited and continuation was problematic. This first umbrella review on CVD risk reduction in Indigenous women suggests an urgent need for high-quality evidence to inform and make CVD prevention accessible and equitable for them. Future studies should employ consumer-led, innovative, and context-specific strategies to ensure inclusive recruitment and sustain participant engagement.