Does gender influence the outcome of ischemic heart disease?
Michał Tomaszewski1, Weronika Topyła1, Bartosz Grzegorz Kijewski1
1Department of Cardiology, Medical University of Lublin, Poland.
Insights
Cardiovascular diseases affect men and women differently. Women experience unique ischemic heart disease symptoms and diagnostic challenges due to sex-based variations in coronary vasomotor function.
Area of Science:
- Cardiology
- Cardiovascular Research
- Sex Differences in Medicine
Background:
- Cardiovascular diseases (CVDs) cause significant mortality in both sexes, with women experiencing higher death rates.
- Historically, ischemic heart disease (IHD) manifestations were considered similar in men and women.
- Emerging evidence highlights sex-based disparities in IHD presentation, diagnosis, and underlying pathology.
Purpose of the Study:
- To investigate sex-based differences in the clinical presentation and diagnosis of ischemic heart disease.
- To explore the role of coronary vasomotor function in sex disparities observed in IHD.
- To understand how these differences impact mortality and quality of life for women with IHD.
Main Methods:
- Comparative analysis of clinical manifestations and diagnostic test results between male and female IHD patients.
- Assessment of coronary vasomotor response to physiological and pharmacological stimuli (e.g., mental stress, acetylcholine).
- Evaluation of epicardial and microvascular coronary function in relation to sex.
Main Results:
- Significant differences exist in the diagnostic process and pathological mechanisms of cardiovascular diseases between men and women.
- Women exhibit higher susceptibility to coronary vasomotor dysfunction, including increased sensitivity to catecholamines and acetylcholine, leading to myocardial ischemia.
- Coronary artery spasm and microvascular dysfunction are more prevalent in women, contributing to poorer outcomes.
Conclusions:
- Sex-based differences in coronary vasomotor function significantly influence the presentation and diagnosis of ischemic heart disease.
- Women with IHD face unique challenges due to heightened sensitivity of their coronary vessels, resulting in higher mortality and reduced quality of life.
- Understanding these sex-specific mechanisms is crucial for improving diagnosis and treatment strategies for cardiovascular diseases in women.
Abstract:
Diseases of the cardiovascular system (myocardial infarction, stroke, heart failure, hypertensive heart disease, cardiomyopathy) account for 40% of all deaths in men and up to 49% of all deaths in women. For a long time it was thought that the clinical picture of ischemic heart disease in men and women was similar. Now, however, there are more reports suggesting that diverse manifestations of the symptoms of ischemic disease may be related to differences between sexes. The disparity between women and men is also evident in the diagnostic process, and various pathological mechanisms of cardiovascular diseases, in particular myocardial ischemia in men and women, affect the differences in the results of diagnostic tests. Vasomotor dysfunction is particularly frequent in women, as their coronary vessels are more sensitive to the catecholamines released during mental stress, resulting in spasm and ischemic myocardium. Moreover, a much lower dose of acetylcholine induced vasoconstriction, which indicates that women are more sensitive to this neurotransmitter. Therefore, coronary vasomotor disorders in the form of epicardial and microvascular dysfunction are more often seen in women. All these mentioned factors resulted in higher mortality and poorer quality of life of women suffering from ischemic heart disease.
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