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Ischemic heart disease in Women: are there sex differences in pathophysiology and risk factors?

Basic Sciences, Pharmacology, Genomics and Cardiovascular Pathology

First published online: 02 July 2013

Access the full article online

Nature Reviews Cardiology 10: 508-518, 2013

Viola Vaccarino, Lina Badimon, Roberto Corti R, Cor de Wit, Maria Dorobantu, Olivia Manfrini, Akos Koller, Axel Pries, Edina Cenko, Raffaelle Bugiardini

Scientific interest in ischaemic heart disease (IHD) in women has grown considerably over the
past 2 decades. A substantial amount of the literature on this subject is centred on sex differences in clinical
aspects of IHD. Many reports have documented sex-related differences in presentation, risk profiles, and
outcomes among patients with IHD, particularly acute myocardial infarction. Such differences have often
been attributed to inequalities between men and women in the referral and treatment of IHD, but data are
insufficient to support this assessment. The determinants of sex differences in presentation are unclear,
and few clues are available as to why young, premenopausal women paradoxically have a greater incidence
of adverse outcomes after acute myocardial infarction than men, despite having less-severe coronary artery
disease. Although differential treatment on the basis of patient sex continues to be described, the extent to
which such inequalities persist and whether they reflect true disparity is unclear. Additionally, much uncertainty
surrounds possible sex-related differences in response to cardiovascular therapies, partly because of a
persistent lack of female-specific data from cardiovascular clinical trials. In this Review, we assess the
evidence for sex-related differences in the clinical presentation, treatment, and outcome of IHD, and identify
gaps in the literature that need to be addressed in future research efforts.