[Acute coronary syndrome in women below 60 years of age]

Women below 60 years of age with acute coronary syndrome (ACS) have higher in-hospital and 1-year mortality rates than similarly aged men, despite the lower prevalence of obstructive coronary artery disease. When ACS occurs, gender differences in symptom presentation result in later recognition by female patients themselves and by their doctors. Women with ACS have relatively more pain in the neck, back and shoulders with concomitant vaso-vegetative symptoms, feelings of anxiety, fatigue, and dyspnoea in comparison with the classical chest pain syndrome that is more prevalent in men. At a younger age smoking and a positive family history are stronger risk factors for ACS in women than in men, and the use of oral contraceptives further elevates their risk.