Women with non‐ST‐elevation acute coronary syndromes remain understudied and undertreated
Ischaemic heart disease is the leading cause of death for women worldwide, and sex‐related disparities continue to characterise its management.1 Despite initiatives addressing this problem, cardiovascular risk in women is still underestimated and guideline recommendations have failed to develop sex‐specific strategies, primarily because women are underrepresented in clinical trials.1,2,3 In particular, sex‐specific pathophysiological mechanisms of ischaemic heart disease have not been fully elucidated; for example, acute coronary syndromes (ACS) are more frequently associated with non‐obstructive coronary artery disease and spontaneous coronary dissection in women than in men.4,5 Further, the symptoms of myocardial infarction may be different in women, and this contributes to its under‐recognition and, ultimately, to delays in appropriate treatment.6
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- 1. Vogel B, Acevedo M, Appelman Y, et al. The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030. Lancet 2021; 397: 2385–2438.
- 2. Bairey Merz CN, Andersen H, Sprague E, et al. Knowledge, attitudes, and beliefs regarding cardiovascular disease in women: the Women’s Heart Alliance. J Am Coll Cardiol 2017; 70: 123–132.
- 3. Cushman M, Shay CM, Howard VJ, et al; American Heart Association. Ten‐year differences in women’s awareness related to coronary heart disease: results of the 2019 American Heart Association National Survey. A special report from the American Heart Association. Circulation 2021; 143: e239–e248.
- 4. Adlam D, Alfonso F, Maas A, Vrints C; ESC‐ACCA Writing Committee. European Society of Cardiology, acute cardiovascular care association, SCAD study group: a position paper on spontaneous coronary artery dissection. Eur Heart J 2018; 39: 3353–3368.
- 5. Collet JP, Thiele H, Barbato E, et al; ESC Scientific Document Group. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST‐segment elevation. Eur Heart J 2021; 42: 1289–1367.
- 6. Khan NA, Daskalopoulou SS, Karp I, et al; GENESIS PRAXY Team. Sex differences in acute coronary syndrome symptom presentation in young patients. JAMA Intern Med 2013; 173: 1863–1871.
- 7. Bachelet BC, Hyun K, D'Souza M, et al. Sex differences in the management and outcomes of non‐ST‐elevation acute coronary syndromes. Med J Aust 2021; 215: 153–155.
- 8. Kunadian V, Chieffo A, Camici PG, et al. An EAPCI expert consensus document on ischaemia with non‐obstructive coronary arteries in collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. Eur Heart J 2020; 41: 3504–3520.
- 9. Wilkinson C, Bebb O, Dondo TB, et al. Sex differences in quality indicator attainment for myocardial infarction: a nationwide cohort study. Heart 2019; 105: 516–523.
- 10. Alabas OA, Gale CP, Hall M, et al. Sex differences in treatments, relative survival, and excess mortality following acute myocardial infarction: national cohort study using the SWEDEHEART Registry. J Am Heart Assoc 2017; 6: e007123.
Roxana Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol‐Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Insel Gruppe, Medtronic, OrbusNeich, Philips, Transverse Medical, and Zoll; personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine (CIRM), Cine‐Med Research, Janssen, WebMD, and SCAI; consulting fees (paid to her institution) from Abbott, Abiomed, AM‐Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, CSL Behring, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; and has equity (less than 1%) in Applied Therapeutics, Elixir Medical, and STEL, and her spouse has similarly minor equity in CONTROLRAD. She sits on the scientific advisory boards for the American Medical Association and the Cardiovascular Research Foundation (no fee); her spouse sits on the Biosensors scientific advisory board.