Women and the management of acute coronary syndrome
Petr Ostadal1, Bohuslav Ostadal
1Cardiovascular Center, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic. ostadal.petr@gmail.com
Insights
Women with coronary heart disease (CHD) are under-represented in clinical trials. Research is needed for female-specific acute coronary syndrome (ACS) treatment strategies, as outcomes vary by sex.
Area of Science:
- Cardiology
- Clinical Trials
- Sex Differences in Medicine
Background:
- Coronary heart disease (CHD) is a leading cause of death globally.
- Females remain under-represented in clinical trials for CHD, leading to limited evidence on sex-specific aspects of acute coronary syndrome (ACS).
- Women often receive less invasive procedures and evidence-based pharmacotherapy compared to men.
Purpose of the Study:
- To review the current evidence on sex differences in the pathogenesis, management, and outcomes of acute coronary syndrome (ACS).
- To highlight the disparities in treatment and outcomes between men and women with ACS.
- To emphasize the need for female-specific research and therapeutic strategies in ACS.
Main Methods:
- Literature review of studies examining sex differences in ACS.
- Analysis of treatment patterns and outcomes in male and female patients.
- Evaluation of the efficacy of various pharmacotherapies and interventions in different sexes.
Main Results:
- Women benefit equally from invasive approaches and coronary interventions in ACS, despite older age and higher bleeding risk.
- Beta-blockers, ACE-inhibitors, and statins show comparable cardiovascular event reduction in both sexes.
- Women may derive less benefit from fibrinolytic or glycoprotein IIb/IIIa inhibitors, while aspirin efficacy is similar; clopidogrel data is conflicting.
Conclusions:
- Despite similar benefits from some therapies, women experience sex-specific differences in ACS management and outcomes.
- There is an urgent need for more research to develop female-specific therapeutic strategies for ACS.
- Understanding the mechanisms behind sex differences is crucial for optimizing ACS treatment in women.
Abstract:
Coronary heart disease (CHD) is the leading cause of morbidity and mortality in both men and women in the developed countries. Despite this fact, females are still under-represented in the majority of clinical trials. At the present time, only limited evidence is available with respect to the female-specific aspects of pathogenesis, management, and outcomes in acute coronary syndrome (ACS). Women less frequently undergo coronary intervention, and a lower proportion of women receive evidence-based pharmacotherapy, compared with men. It has been shown that women benefit from an invasive approach and coronary intervention in ACS as much as men, despite their advanced age and higher rate of bleeding complications. Also, administration of beta-blockers, ACE-inhibitors, and intensive statin therapy is associated with a comparable reduction of cardiovascular event rates in women and men. On the other hand, women may profit less than men from fibrinolytic or glycoprotein IIb/IIIa inhibitor therapy. Both sexes benefit equally from aspirin therapy, whereas contradictory data are available on the efficacy of clopidogrel in women. There is an urgent need for intensive research in the development of female-specific therapeutic strategy in ACS, even though the detailed mechanisms of sex differences are still unknown.
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