According to new research in Arteriosclerosis, Thrombosis, and Vascular Biology cardiovascular disease (CVD) stands as the foremost cause of morbidity and mortality globally, accounting for over 17.9 million deaths in 2019. While strides in medical advancements and guideline recommendations have curtailed ischemic heart disease mortality, significant gender disparities persist. Recent analysis from 15 global studies on cardiovascular disease sheds light on a concerning trend: women face delayed diagnoses and treatments compared to men, leading to graver outcomes.

Key Points

1. Gender Disparities in the ACS Presentation:

   • Women are more likely to present with plaque erosion, spontaneous coronary artery dissection, and non-obstructed coronary arteries.

   • Men are more susceptible to plaque rupture from epicardial coronary artery disease.

2. Outcomes after ACS:

   • Women experience worse outcomes due to poorer risk factor profiles, lower use of reperfusion therapies, and longer delays in seeking treatment.

   • Delayed symptom-to-presentation intervals contribute to adverse outcomes.

3. Underrepresentation in Clinical Trials:

   • Women are underrepresented in cardiovascular trials, hindering the development of gender-tailored treatments.

4. Unique Risk Factors in Women:

   • Recognition and treatment of novel risk factors in women, including systemic inflammatory disorders and pregnancy-related factors, are crucial.

5. Diagnostic Disparities and Early Intervention:

   • Breast arterial calcification and coronary calcium scoring aid in the early detection of subclinical atherosclerosis, allowing for timely preventive interventions.

6. Physician Gender Impact:

   • Studies show that women treated by female doctors exhibit notable improvements in prognosis, emphasizing the role of physician gender in outcomes.

Women and men differ in how they experience heart attacks and the factors that contribute to them. Women are more likely to have certain types of heart attacks, such as those caused by plaque erosion or without blocked arteries, while men are more likely to have heart attacks caused by plaque rupture. Women also tend to have worse outcomes after heart attacks, possibly due to a combination of factors such as older age, more health conditions, and lower use of certain treatments. Recognizing and treating these differences is important for improving the overall health of both men and women.

Gender Disparities in Diagnosis and Treatment

Diagnosis Delay

The analysis, encompassing 2.3 million individuals across 50 countries, underscores stark differences in diagnosing, treating, and perceiving symptoms. Notably, women tend to seek medical care later than men after the onset of cardiac symptoms. Physicians, in turn, exhibit disparities in admitting women to hospitals at lower rates compared to men, prolonging diagnosis timelines.

Varied Symptoms and Misinterpretation

The Centers for Disease Control and Prevention (CDC) highlight that more than 60 million American women live with various forms of cardiac disease, making it the primary cause of mortality for both genders. However, the analysis uncovers a critical factor: women may exhibit atypical symptoms beyond chest pain, such as vomiting, jaw pain, and abdominal discomfort. These symptoms, often overlooked by both patients and doctors, lead to delayed diagnoses and subsequent treatment delays.

Escalating Risk Factors and Impact

Heart attack rates among younger women surged from 21% to 31% between 1995 and 2014. Additionally, younger women facing coronary artery disease show a six-fold increased risk of mortality within 30 days. Unique risk factors in women, including premature menopause, endometriosis, and pregnancy-related hypertension disorders, compound the challenges in diagnosis and treatment.

Gender-Influenced Cardiac Outcomes

Impact of Physician Gender

Studies underscore that the gender of the treating physician influences outcomes. In instances where women were treated by female doctors, there were notable improvements in their prognosis.

Addressing Disparities

The review emphasizes the need to address sex, racial, and ethnic differences on a global scale regarding acute coronary syndromes. Highlighting demographic and geographic factors, it emphasizes the need for earlier identification of unique risk factors influencing cardiovascular disease in women.

Biological and Pathophysiological Perspectives

Unique Pathophysiological Profiles

Women exhibit different cardiac pathophysiological presentations, including myocardial infarction in nonobstructive CAD (MINOCA) and spontaneous coronary artery dissection (SCAD). MINOCA cases, often disregarded due to the absence of significant CAD, represent a significant portion of female MI cases.

Spontaneous Coronary Artery Dissection (SCAD)

SCAD, characterized by arterial wall separation, disproportionately affects younger women. Pregnancy-related SCAD cases underscore the influence of sex hormones on disease development.

Atherosclerotic Obstructive CAD

Men display a higher burden of epicardial atheroma, contributing to a greater prevalence of ACS. Plaque rupture and erosion, with distinct prevalences in men and women, further highlight gender-specific cardiac pathologies.

Clinical Perspectives and Disparities

Disparities in Risk Profiles

Women exhibit distinct ACS risk profiles, including age-related risks post-menopause and stronger correlations between diabetes and ACS compared to men.

Presentation Disparities

While chest pain remains a prevalent symptom in both genders, women often present with additional atypical symptoms like jaw pain and nausea. Delays in hospital presentations by women are noted, impacting subsequent outcomes.

Diagnostic and Treatment Disparities

Misdiagnosis and underinvestigation persist in female ACS cases. Variations in troponin-level interpretations between genders, along with disparities in essential ACS treatments and reperfusion therapies, contribute to differing outcomes.

Certainly, here's a breakdown of the key differences in myocardial infarction (MI) and outcomes between men and women based on various factors:

Myocardial Infarction Differences:

WOMEN:

• More prone to myocardial infarction from plaque erosion, spontaneous coronary artery dissection, and nonobstructive coronary arteries.

MEN:

• More likely to experience plaque rupture from epicardial coronary artery disease.

Post-ST-Segment-Elevation Myocardial Infarction Outcomes:

WOMEN:

• Exhibit worse outcomes due to:

  • A poorer risk factor profile.

  • Lower utilization of reperfusion therapies.

  • Reduced use of medications.

  • Delayed symptom-to-presentation intervals.

  • Longer door-to-balloon time, impacting timely intervention.

Outcomes after Percutaneous Coronary Intervention (PCI):

WOMEN:

• Experience worse outcomes attributed to:

  • Older age.

  • Higher rates of hypertension, diabetes, and obesity.

  • Presence of 3-vessel disease.

  • Prolonged door-to-balloon time, even in nations with universal healthcare.

Addressing gender-specific risk factors:

• Recognition and treatment of novel risk factors in women, such as systemic inflammatory disorders and pregnancy-related factors, hold promise for improving their outcomes post-cardiac events.

Diagnostic Methods for Early Intervention:

Breast arterial calcification and coronary calcium scoring emerge as effective methods for detecting subclinical atherosclerosis, enabling early intervention to prevent the onset of clinical coronary artery disease

Understanding these distinct myocardial infarction patterns and post-event outcomes between genders underscores the need for tailored approaches in diagnosis, treatment, and preventive care, ultimately aiming for more equitable healthcare outcomes for both men and women facing cardiac issues.

Conclusion

The gender-based disparities in cardiovascular disease diagnosis, treatment, and outcomes necessitate immediate attention. Addressing the nuances in symptoms, risk factors, and pathophysiological differences between men and women is crucial to bridging these gaps. Achieving equitable healthcare requires comprehensive strategies tailored to gender-specific cardiac manifestations, timely diagnosis, and effective interventions for all individuals.

Reference Article

Khraishah, H., Daher, R., Garelnabi, M., Karere, G., & Welty, F. K. (2023). Sex, Racial, and Ethnic Disparities in Acute Coronary Syndrome: Novel Risk Factors and Recommendations for Earlier Diagnosis to Improve Outcomes. Arteriosclerosis, Thrombosis, and Vascular Biology, 43(8), 1369–1383. https://doi.org/10.1161/atvbaha.123.319370

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Related

https://healthnewstrend.com/heart-failure-in-women-understanding-the-gender-disparity

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