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Perspectives

Does gender make a difference when managing cardiovascular disease?

Kate Rankin, Justin Mariani

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Abstract

Over recent years, there have been significant improvements in the understanding of the role of gender in the pathophysiology, clinical manifestations and optimal treatment of cardiovascular disease (CVD). Despite this, disparities remain in the prevention, investigation and management of CVD in women.

Key Points

  • Cardiovascular disease (CVD) is the leading cause of death among women. Compared with men, women generally present later and are more likely to die with CVD, either as a primary presentation or in combination with comorbidities.
  • Certain traditional risk factors for CVD such as diabetes, dyslipidaemia and hypertension have both a higher prevalence and exert greater overall risk in women than men.
  • Adverse coronary reactivity, microvascular dysfunction and plaque erosion/distal embolisation have been implicated as being significant contributors to the female-specific pathophysiology of myocardial ischaemia.
  • Although women with acute coronary syndrome (ACS) do present with typical symptoms such as chest pain, they are more likely than men to present with atypical symptoms and with non-ST elevation ACS rather than ST elevation myocardial infarction.
  • Compared with men, women often receive less intensive risk factor management before a coronary event and less intensive medical therapy, lifestyle counselling and cardiac rehabilitation after the event.
  • Despite the distinct differences in both the pathophysiology and presentation of CVD in women and men, no discrepancies should exist in active detection and management of CVD. Further trial evidence is essential to determine the most appropriate CVD treatment based on gender.

    Picture credit: © Science Source/Jim Dowdalls/Diomedia.com

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