Women and coronary artery disease. Part I: basic considerations

Area of Science:

• Cardiology
• Women's Health
• Public Health

Background:

• Cardiovascular disorders (CVD) are the leading cause of death in women, surpassing cancer.
• Coronary artery disease (CAD) mortality is high in women, with concerning trends in younger populations and higher pre-hospitalization death rates compared to men.
• A significant knowledge gap exists regarding CVD in women, stemming from a historical focus on male-centric research, leading to disparities in awareness, risk assessment, and treatment.

Purpose of the Study:

• To highlight the critical need for improved awareness and sex-specific approaches to cardiovascular disease in women.
• To advocate for the development and adoption of gender-specific risk assessment tools for coronary artery disease (CAD).
• To emphasize the importance of understanding female-specific pathophysiological mechanisms in CAD.

Main Methods:

• Review of epidemiological data on cardiovascular disease mortality in women compared to other major diseases.
• Analysis of trends in sudden cardiac death and pre-hospitalization mortality rates between genders.
• Discussion of current limitations in risk assessment tools (e.g., Framingham Risk Score) for women and the potential of alternatives (e.g., Reynolds Risk Score).
• Exploration of pathophysiological differences, particularly endothelial and microvascular dysfunction, in female CAD.

Main Results:

• Women experience higher mortality from cardiovascular disorders than from a combination of major cancers and lung disease.
• While age-adjusted CAD mortality shows mixed trends, young women face increasing risks, and women are more likely to die before reaching emergency care.
• Existing risk assessment models are often inadequate for women, necessitating the use of more appropriate tools like the Reynolds Risk Score.
• Endothelial and microvascular dysfunction are key contributors to non-obstructive CAD in women, an area underrepresented in research.

Conclusions:

• There is an urgent need to increase awareness of cardiovascular disease risks among women and healthcare providers.
• Current diagnostic and treatment strategies for CAD require adaptation to address female-specific pathophysiology and risk factors.
• Further research focusing on women's cardiovascular health, including enrollment in clinical trials and investigation of sex-specific mechanisms, is essential to reduce the burden of CAD in this population.