Coronary artery disease and acute coronary syndrome in women
Julinda Mehilli1,2, Patrizia Presbitero3
1Cardiology, University Hospital Munich, Munchen, Germany julinda.mehilli@med.uni-muenchen.de.
Insights
Women with acute coronary syndrome (ACS) present later, face higher bleeding risks, and have unique risk factors. Young women with ACS have a higher mortality risk, necessitating targeted research and interventions.
Area of Science:
- Cardiology
- Internal Medicine
- Women's Health
Background:
- Acute coronary syndrome (ACS) presents differently in men and women regarding clinical symptoms, comorbidities, and cardiovascular risk factors.
- Women with ACS are often older and frailer, presenting later after symptom onset and experiencing higher bleeding risks post-procedure.
- Unique risk factors for ACS in younger women include autoimmune/inflammatory diseases, fibromuscular dysplasia, polycystic ovary syndrome, early menopause, and a history of pre-eclampsia.
Purpose of the Study:
- To highlight the significant differences in ACS presentation, risk factors, and outcomes between men and women.
- To emphasize the diagnostic and therapeutic challenges posed by myocardial infarction in the absence of obstructive coronary arteries (MINOCA) in women.
- To underscore the increased mortality risk in young women with ACS and the need for specialized research and care.
Main Methods:
- Comparative analysis of clinical presentation, comorbidities, and cardiovascular risk factors in male and female ACS patients.
- Review of outcomes, including bleeding risk and mortality, following guideline-recommended treatments.
- Focus on specific subgroups, particularly young women and those with MINOCA.
Main Results:
- Women with ACS present later, have higher bleeding risks, and are more prone to MINOCA compared to men.
- Despite guideline-recommended treatments, women with ACS face a higher adjusted risk of early death, which equalizes within the first year.
- Young women with ACS exhibit a higher risk of death compared to young men, often accompanied by depression and MINOCA.
Conclusions:
- ACS management requires tailored approaches considering sex-specific differences in presentation, risk factors, and pathophysiology.
- Further research into MINOCA and the development of programs addressing comorbidities and depression in young women with ACS are crucial.
- Addressing these disparities is essential to improve outcomes and reduce mortality in female ACS patients.
Abstract:
There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset and are at high bleeding risk after invasive procedures. In addition, autoimmune/inflammatory disease, fibromuscular dysplasia, polycystic ovary, early menopause and history of pre-eclampsia are risk factors preceding ACS among younger women. They more often experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA), which makes diagnosis and treatment of ACS among women more challenging compared with men. Women and men do both benefit from guideline-recommended treatment, although, compared with men, women with ACS have a higher adjusted risk of early death, which equalises between both sexes within the first year. Young women with ACS suffer frequently of depression and present often with MINOCA. Compared with young men, they (young women) have a higher risk of death. Therefore, focusing on young patients with ACS, understanding the particular physiopathology of MINOCA and developing programmes targeting comorbidities and depression-related behavioural risk factors are urgently needed.
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