Acute coronary syndrome: the risk of being female.

Abstract

Coronary heart disease is the leading cause of mortality and morbidity in industrialized countries, in men as well as in women. Women have their first cardiac event 6 to 10 years later than men do. Whereas the cardiovascular death rates are declining in men, they remain constant in women. In cardiovascular studies with age limits, women are naturally the minority, amounting to <40%. It is well known that distinct gender differences exist in terms of presentation of symptoms, validity of diagnostic tests, drug side effects, and complications. With respect to cardiac risk factors, women have higher rates of diabetes and hypertension but are less frequently smokers. See p 580 Women with acute coronary syndrome (ACS) call later for professional help and present more frequently with atypical symptoms, such as abnormal pain locations, nausea, vomiting, fatigue, and dyspnea. We can only speculate on the reasons for these differences, but they could be related to different pain perception, older age, or other comorbidities. ECG as the first-line diagnostic tool in ACS is also less reliable in females presenting to emergency rooms. There are less frequent ST elevations and higher rates of ST depressions and T-wave inversions, as well as nonspecific alterations. The type of ischemic event shows gender-specific differences. According to studies such as GUSTO IIb (Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes),1 TIMI IIIB (Thrombolysis In Myocardial Infarction),2 and the Euro Heart Survey,3 women present more frequently with unstable angina and non–ST-elevation myocardial infarction (NSTEMI), whereas men have ACS with ST elevation (STEMI). The outcome in NSTEMI appears equal, but in STEMI, mortality is higher in women. Women seem to be evaluated less intensively, which is possibly related to the perception that coronary artery disease is predominately a male disease. Cardiac-specific biochemical …