Sex and gender differences in symptoms of myocardial ischaemia

Abstract

This editorial refers to Gender differences in symptoms of myocardial ischaemia', by M.H. Mackay et al ., doi:10.1093/eurheartj/ehr358 . Women with acute coronary syndromes (ACS) or myocardial infarction (MI) still undergo treatment significantly later than men. The reasons for this are unclear, but so-called ‘atypical symptoms’ in women have been under suspicion.1 Women are assumed to complain of anginal symptoms that differ from the classical picture of those of men, making diagnosis more difficult and delaying effective therapy. This phenomenon is of great relevance for healthcare in women and therefore has been investigated in numerous studies.2 It has been discussed whether sex or gender is the crucial factor for different presentation—whether differences exist between women and men in the biological mechanisms of pain, i.e. sex, or whether socio-cultural mechanisms, such as lack of awareness of risk or reporting behaviour, mainly contribute to the differences, i.e. gender. Do women have a different form of angina from men, do they interpret pain differently, or do they report it differently? A significant number of studies analysing sex and gender differences in the presentation of MI and angina pectoris agree that women differ from men in their reported symptoms, even though the differences may be small. Most of these studies necessarily had a retrospective design, inquiring of patients after the events concerning the related symptoms. Only studies that focus on a first MI avoid the recall effect—that patients learn from doctors and friends during a first MI which symptoms are to be expected. In such studies, relatively persistent findings are the greater number of symptoms in women and the greater frequency of nausea and pain in the throat or jaws, among others.3 The large WISE study investigated a broader spectrum of women,4 covering all women presenting with chest pain in the participating …