Gender Differences in the Treatment for Acute Myocardial Infarction

Abstract

Accumulating evidence over the last several decades regarding the treatment and outcomes for coronary artery disease reveals disparities that have a clear relationship to gender. It had previously been thought that these differences were related to gender bias in physicians’ approach to treatment; thus, the term Yentl syndrome was coined in 1991.1 As the volume of literature expanded and clinical studies included more women, it became clear that outcomes after treatment for coronary artery disease, particularly acute myocardial infarction, were different for women compared with men. Women have a well-documented higher mortality after acute myocardial infarction.2 Much of this disparity has been attributed to differences in age and attendant comorbidities. Female patients with coronary artery disease typically are older, have a higher prevalence of risk factors, and have a lower functional status than their male counterparts.3,4 Additionally, women appear to be at higher risk than men when diabetes, hypertriglyceridemia, and metabolic syndrome are present. The underuse of revascularization procedures in women has been suggested as an explanation, but it has not been uniformly demonstrated to explain increases in mortality. Some studies have suggested a link to less aggressive hospital care of female patients, including the underuse of revascularization, as an explanation for their increased mortality.5 Other studies have indicated age and comorbidity as the primary factors leading to mortality differences.6 Still other studies suggest no evidence of undertreatment.7,8 Article p 833 Gender differences in the clinical outcome of patients with acute myocardial infarction may be explained in part by the female status. Several conditions found only in women hint at differences in the pathophysiology of ischemic vascular disease between the sexes. Such female-specific conditions include early menopause, gestational diabetes, peripartum vascular dissection, preeclampsia and eclampsia, polycystic ovarian syndrome, low-birth-weight children, and hypothalamic hypoestrogenemia. Several …