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Sex differentiation with regard to coronary artery disease
Nikolaos A Papakonstantinou1, Maria I Stamou, Nikolaos G Baikoussis
1General Surgery Department, University Hospital of Ioannina, School of Medicine, 45500 Ioannina, Greece. nikppk@yahoo.gr
Insights
Coronary artery disease (CAD) is the leading cause of death in women, with significant sex-related differences in presentation, diagnosis, and treatment. Women face poorer prognoses and higher mortality rates from CAD compared to men.
Area of Science:
- Cardiology
- Cardiovascular Disease
- Gender Medicine
Background:
- Coronary artery disease (CAD) was historically viewed as a male-specific condition.
- CAD is now the leading cause of death in women globally.
- Significant sex-based disparities exist in CAD presentation, diagnosis, treatment, and outcomes.
Purpose of the Study:
- To review and discuss the sex-related differences in coronary artery disease.
- To highlight the unique challenges women face with acute myocardial infarction (AMI).
- To underscore the importance of understanding gender-specific aspects of CAD.
Main Methods:
- Literature review of current research on sex differences in CAD.
- Analysis of gender-related variations in AMI presentation, diagnosis, and treatment.
- Examination of prognostic factors and complications in female CAD patients.
Main Results:
- Women exhibit distinct physiological differences, including smaller, stiffer hearts and vessels, and greater atherosclerosis.
- Diagnosis in women is complicated by atypical symptoms, more false-negative tests, and delayed care-seeking.
- Women experience higher early mortality, increased complications (bleeding, shock, heart failure), and poorer long-term physical and mental health post-AMI.
Conclusions:
- CAD presents unique challenges in women, necessitating tailored diagnostic and treatment strategies.
- Addressing gender disparities is crucial for improving outcomes in female CAD patients.
- Further research into sex-specific CAD mechanisms and management is warranted.
Abstract:
Coronary artery disease was considered a male disease for many years. However, nowadays, coronary artery disease constitutes the leading cause of death in women, although there are a lot of gender-related differences regarding the presentation of acute myocardial infarction, its diagnosis, its treatment, short- and long-term mortality rates, and post-acute myocardial infarction complications. Generally, women have smaller and stiffer hearts and cardiac vessels, suffering a greater extent of atherosclerosis and endothelial and smooth muscle dysfunction. They are usually older than men and they have more comorbidities such as hypertension, renal impairment, and diabetes mellitus. Moreover, female coronary artery disease, the diagnosis of which is more complicated due to more false negative results of some diagnostic methods in women, is more often presented with atypical symptoms and women's symptoms of typical or atypical angina are more severe. Furthermore, women delay significantly more in seeking care and they are more frequently undertreated. Finally, women are associated with generally poorer in-hospital and long-term prognosis having almost two-fold higher early mortality and they are more prone to complications such as bleeding complications, shock, and heart failure, as well as to post-myocardial infarction depression and poorer physical function and mental health. In this review, we discuss these sex-related differences according to current literature.
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