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Circulation. 2018;138:1082–1084. DOI: 10.1161/CIRCULATIONAHA.118.034612 1082 Nanette K. Wenger, MD Beverly H. Lorell, MD C. Noel Bairey Merz, MD C ardiovascular disease (CVD) remains the leading contributor to morbidity and mortality in women. Application of evidence-based, sex-specific information in clinical care has substantially decreased CVD mortality among US women from 1 in every 2 women in the year 2000 to 1 in 4 women at present. In this context, the guidance by the Department of Health and Human Services, which instructed the Centers for Disease Control and Prevention on December 26, 2017, not to use 7 words in its 2019 budget appropriation request—diversity, transgender, vulnerable, fetus, entitlement, evidence-based, and science-based—will undermine science and research integrity in women’s health.1 Specific to women, because of the links between general and reproductive health, this guidance and related administration policy changes will disproportionately adversely affect women. Because CVD is the leading health threat for women of all ages, these recent legislation and public policy changes are particularly relevant to the cardiovascular community. As outlined in the World Health Organization (Promoting Health Through the Life-Course), among the 10 top issues for women’s health, noncommunicable diseases such as CVD are inextricably linked to issues specific to women and girls, including breast and cervical cancer, reproductive health, HIV and sexually transmitted disease, violence against women, and growing older with fewer pensions and benefits. Given this interplay of sex-specific health issues for women, reductions in access to and funding for medical care disproportionately adversely affect women. CVD remains underaddressed in nonreproductive women’s health care. In a nationally representative survey of US community women and physicians, CVD in women remained largely invisible with multiple barriers to care.2 Weight and breast health were ranked higher than CVD for women by primary care physicians. Social stigma concerning body weight is reported as a barrier to women discussing heart health.2 In another study, women reported 3 specific barriers to CVD diagnosis and treatment: They had to struggle to take a cholesterol test; they perceived that their risk was downplayed by doctors; and their symptoms of coronary heart disease were misinterpreted when they consulted doctors for evaluation and treatment. Combined with physician-reported barriers to CVD treatment, socioeconomic issues, the cost of care, and lack of a multidisciplinary team place women disproportionately at risk for no or suboptimal CVD health care. The Patient Protection and Affordable Care Act (ACA; Public Law No. 111-148) extended healthcare coverage to ≈20 million predominantly low-income Americans. From 2013 to 2015, the uninsured rate of US women fell from 17% to 11% among those 19 to 54 years of age. This legislation promoted women’s health in a number of specific ways. Before the ACA, coverage could be denied on the basis of preexisting conditions, which included pregnancy for women. Furthermore, the ACA reversed prior sex inequities by eliminating the 10% to 50% higher premiums charged to women, including women beyond reproductive age. The ACA access to the 10 “minimal essential coverage” benefit requirements is particularly relevant to CVD by © 2018 American Heart Association, Inc. ON MY MIND