Gender bias in cardiovascular disease prevention, detection, and management, with specific reference to coronary artery disease

Abstract

Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.

Association of Dietary Pattern, Lifestyle and Chronotype with Metabolic Syndrome in Elderly—Lessons from the Population-Based Hamburg City Health Study

“…As expected from previous research, adherence to the DASH diet seemed to be cardio-protective [ 7 , 23 ]. The prevalence of conventional cardiovascular risk factors was slightly but significantly lower in the highest tertile compared to the lowest.…”

“…This finding can be explained predominantly by hormonal and metabolic changes that occur during the menopause transition. Actually, estrogen loss adversely alters body fat distribution, cholesterol profile, blood pressure, and increased insulin resistance [ 23 ].…”

“…Chronotype has often been linked to dietary intake. Individuals with “late” chronotype particularly follow an unhealthier dietary behavior [ 10 , 13 , 23 , 29 ]. These studies are largely supportive of our findings.…”

Diagnoses and Outcomes of Patients with Suspicion of Acute Coronary Syndrome and Raised High Sensitive Troponin I: A Single Center Study from Pakistan

“…4 Recommendations by the IFCC working group and AACC 4 also include reporting the results of high sensitive assays in whole numbers (ng/L) rather than decimals which are used in conventional assays, and running three levels of internal quality controls every day of use, with values of the low-level control at the 99 th percentile URL. Alinity i STAT Hs-Troponin I Controls at three levels (20,200, and 1500 ng/L) were used to monitor the quality of the assay in our laboratory. The analytical coefficient of variation (CV) of the assay at the 99th percentile URL was less than 7% during the study interval.…”

Evolución de la ginecología peruana al Bicentenario, y el futuro

“…Debido a la inactividad física y a la obesidad central, el SM es más frecuente en las mujeres, especialmente en las posmenopáusicas. Con la pérdida de estrógenos, la menopausia marca una transición biológica cardiovascular crítica, con riesgo de ECV significativamente mayor en las mujeres mayores de 55 años (47) .…”