Women, Acute Ischemic Heart Disease, and Antithrombotic Therapy

Abstract

There now exists an extensive and growing literature examining gender-based differences in the pathobiology, presentation, treatment patterns, and clinical outcomes of ischemic heart disease (IHD). IHD is a dominant mode of death for women,1 and, for >20 years, more women than men die annually from IHD.2 The first manifestation of IHD in women is frequently myocardial infarction or sudden cardiac death.2 A better understanding of the spectrum of issues—from pathophysiology through implementation of evidence-based care—among women with IHD is a public health imperative. Article p 2822 Recently, many observations have converged around a common set of themes in the care of women with IHD, especially acute IHD. Lansky et al3 have pointed out that women with degrees of obstructive coronary artery disease comparable to those of men receive less revascularization. From the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) registry, we know that women presenting with high-risk non–ST-segment–elevation acute coronary syndromes (primarily myocardial infarction) are less likely than men to undergo an early invasive management strategy despite being at a higher baseline risk.4 Women with non–ST-segment–elevation acute coronary syndromes are less likely than men to receive recommended evidence-based medications and cardiac procedures, again despite being at higher baseline risk.5 However, there are also challenges in evaluating and deciding on treatments for women presenting with acute coronary syndromes. Roe and colleagues6 have shown that women presenting with non–ST-segment–elevation acute coronary syndromes have a greater likelihood of nonobstructive disease than do men, and the Women’s Ischemia Syndrome Evaluation (WISE) investigators have compiled a substantial body of work suggesting that the pathobiology of IHD differs in women compared with men.7 All of this makes it imperative that we perform enough research in women …