Abstract

In recent years, increasing attention has been reserved to the analysis of sex-related differences in pathophysiology and prognosis of ischemic heart disease (IHD). The traditional conventional cardiovascular risk factors (hypertension, hypercholesteremia, diabetes mellitus and cigarette smoking) are still considered the major risk factors for IHD in both sexes. Nevertheless, recent studies show that they may interact with male and female coronary anatomy in a different manner. The path to sex-specific risk stratification of IHD is also supported by differences in inflammation and necrosis biomarkers (such as C-reactive protein and troponins, respectively). Indeed, large cohort studies often show different mean values of these markers in men and women. The current review summarizes the state-of-art knowledge on sex-related differences in cardiovascular risk factors and cardiac biomarkers with a prognostic value.

Highlights

  • Over the past decades, increasing attention has been reserved to the analysis of differences between men and women in the pathophysiology, diagnostic, and prognosis of cardiovascular diseases (CVD) [1,2,3,4,5]

  • While it is true that women develop CVD approximately 10 years later than men, it has been observed that female patients do have higher early case fatality rates and higher 1-year mortality rates, when affected by myocardial infarction [7,8,9]

  • Smoking and diabetes mellitus disproportionally increase the risk of obstructive coroanry artery disease (CAD) in women, and as so they are key factors in explaining sex differences in outcomes from acute coronary syndromes (ACS)

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Summary

Sex differences in myocardial infarction and ischemia

Over the past decades, increasing attention has been reserved to the analysis of differences between men and women in the pathophysiology, diagnostic, and prognosis of cardiovascular diseases (CVD) [1,2,3,4,5]. In a recent study by Cenko et al [14] it was demonstrated that female patients, especially if younger than 60 years, have higher rates of 30day mortality after ST-segment elevation myocardial infarction (STEMI) than younger men did even after adjustment for comorbidities and treatment covariates (odd ratio [OR], 1.88; 95% confidence interval [CI], 1.04–3.26) These data, supported by findings from other cohorts, clearly suggest that the differences in prognosis after an acute myocardial infarction (AMI) in men and women cannot be reconducted to gender-related disparities alone, but may be caused by intrinsic biological differences between the two sexes. The current review aims to report current evidence on these aspects

Cardiovascular risk factors
Markers of inflammation
Troponins
Other biomarkers of cytonecrosis
Markers of myocardial dysfunction
Findings
Conclusions
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