Importance of gender differences in the diagnosis and management of patients with Acute Coronary Syndromes: The GRACE study in an Argentine Population

Abstract

Coronary heart disease is the leading cause of mortality and morbidity in industrialized countries, in men as well as in women. Whereas the cardiovascular death rates are declining in men, they remain constant in women. Women with acute coronary syndrome (ACS) usually present later at hospitals for professional help and show more frequently with atypical symptoms, such as abnormal pain locations, nausea, vomiting, fatigue, and dyspnea. So far there are only speculations to explain these differences, but they could be related to different pain perception, older age, or other comorbidities (1). The misperception that females are somehow protected against cardiovascular disease may be one factor at the moment to evaluate the risk of heart disease women that is often underestimated. Recent data from the National Health and Nutrition Examination Surveys (NHANES) have shown that over the past two decades the prevalence of myocardial infarctions has increased in midlife (35 to 54 years) women, while declining in similarly aged men (1) . This view has also been challenged by Wiviott et al on the basis of an analysis from the TACTICS (Treat angina with Aggrastat and determine Costs of Therapy with Invasive or Conservative Strategies)–TIMI 18 study population (2). The under-recognition of heart disease and differences in clinical presentation in women lead to less aggressive treatment strategies. According to studies such as GUSTO IIb (Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes) (3), TIMI IIIB (Thrombolysis In Myocardial Infarction) (4), and the Euro Heart Survey (5), 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. Cardiac-specific biochemical markers, like troponins, seemed a good tool independent of gender in identifying patients at risk. In patients with non–ST-elevation ACS,