Sex Differences in Ischemic Heart Disease

Abstract

Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex-and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.by guest on May 7, 2018

Indicadores de doenças crônicas não transmíssiveis em mulheres com idade reprodutiva, beneficiárias e não beneficiárias do Programa Bolsa Família

“…It is also emphasized that the cause of these disparities is multifactorial and is associated with low levels of education and income. Some studies have previously demonstrated these inequities for cardiovascular disease 14 , for example, and also for some of the most prevalent risk factors among women with low levels of education 11 . Additionally, they have shown the high prevalence of obesity 12 , usually associated with low-income populations and racial inequalities 13,37 .…”

“…A previous study with the Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Survey (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico -Vigitel) found that women of reproductive age with low levels of education were more inactive, and had higher levels of smoking and hypertension 11 . Cardiovascular diseases are also treated and prevented to a lesser extent among women, especially those who are in positions of social vulnerability 14 . Moreover, due to gender inequality, sexist practices place women in unfavorable situations, which are further aggravated by economic inequality 15,16 .…”

Sex differences underlying preexisting cardiovascular disease and cardiovascular injury in COVID-19

“…Hypertension and history of CVD, both already known to increase COVID-19 severity and mortality [ 17 ], display strong sex differences with males exhibiting a higher prevalence of disease compared to age-matched women, prior to menopausal years [ 18 , 19 ]. On the other hand, women experience relatively worse outcomes of ischemic heart disease compared with men [ 20 ]. In HF, the overall lifetime risk is similar between men and women, there are marked sex differences in the variations of this condition, with males being predisposed to HF with reduced ejection fraction (HFrEF) and females to HF with preserved ejection fraction (HFpEF) [ 21 ].…”

Differences in Clinical Features in Patients with Acute Coronary Syndrome and Stroke: Japanese Multicenter Registry Results

“…Based on these limitations, our results should be interpreted with caution. Gender-specific differences in patients' characteristics might be related to atherosclerotic risk factors that are unique to women, including menopause, gestational hypertension and diabetes mellitus ( 18 ). However, data on sex hormone levels and information regarding menstruation and pregnancy were not available in this study.…”