The Swedish paradox: or is there really no gender difference in acute coronary syndromes?

Abstract

This editorial refers to ‘Similar outcome with an invasive strategy in men and women with non-ST-elevation acute coronary syndromes’, by J. Alfredsson et al. , doi:10.1093/eurheartj/ehr349 Over many years, gender differences in medical care have been reported, particularly in the context of cardiovascular disease (CVD). Across the industrialized world, CVD shows a continuous increase over the last decades and is the major cause of morbidity and mortality for men as well as for women.1 Moreover, the impact of CVD on overall mortality rates in Europe is even higher for women than it is for men. Nonetheless, women today outlive men by ∼5–10 years,2 a fact that may be explained by different arguments. One reason for women's longevity is the delay in onset of CVD. Women developing coronary artery disease (CAD) are usually 10 years older than men, who typically develop CAD at the age of 50–60. The risk factors for CAD are well established and do not differ between genders. However, given the older age of onset of clinically relevant CAD, women presenting with acute coronary syndrome (ACS) have a higher frequency of diabetes, hypertension, heart failure, and other co-morbidities.3 Women with ACS are more likely to have had prior episodes of angina pectoris or congestive heart failure, whereas men with ACS are more likely to have had prior myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting.4,5 Differences between women and men with ACS in terms of diagnostic work-up, treatment, and outcome have been reported, but available data are conflicting.6,7 While ACS is quite …