Eliminating Gender Disparities in Coronary Heart Disease Treatment: Are We There Yet?
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INVITED EDITORIAL
Eliminating Gender Disparities in Coronary Heart Disease Treatment: Are We There Yet? Radmila Lyubarova 1 & Gurleen Kaur 2
&
Mandeep S. Sidhu 1
Accepted: 10 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
During the past two decades, the recognition of cardiovascular disease (CVD) as the leading cause of mortality among women has increased [1]. While the incidence of acute coronary syndromes (ACS) and the prevalence of ischemic heart disease in women is lower compared to men, women continue to have increased mortality following ACS [2, 3]. The substantially higher mortality may, in part, be explained by variations in patient factors at presentation such as older age and an increase in comorbidities, but other system-related factors include delay in recognition and treatment [4]. The latest American College of Cardiology/American Heart Association guidelines and European Society of Cardiology guidelines for the management of ST and non-ST elevation myocardial infarction (MI) recommend similar pharmacotherapy goals in both men and women, including beta-blockers, lipid-lowering agents, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and low-dose aspirin, to decrease mortality and morbidity after a MI [5–8]. Nevertheless, several large registry studies have revealed that women are undertreated with guidelinedirected medical therapy and are less likely to achieve secondary prevention targets for hyperlipidemia, hyperglycemia, physical activity, and body mass index, leading to a greater burden of CVD and an increased risk for readmissions [9–11]. In this issue of Cardiovascular Drugs and Therapy, Vynckier et al. [12] report limited gender differences in the medical management of patients with coronary heart disease (CHD). This study involved an analysis of EUROASPIRE V (European Action on Secondary and Primary Prevention by Interventions to Reduce Events)—a cross-sectional study
* Mandeep S. Sidhu [email protected] 1
Division of Cardiology, Department of Medicine, Albany Medical College & Albany Medical Center, 47 New Scotland Ave, Albany, NY 12208, USA
2
Albany Medical College, Albany, NY, USA
conducted between 2016 and 2017 in 27 countries. Patients were eligible for inclusion if hospitalized for acute myocardial ischemia as defined by ICD-10 coding for unstable angina or angina pectoris, acute MI, elective or emergency percutaneous coronary intervention (PCI), or elective or emergency coronary artery bypass grafting (CABG), within a time period of 6 months to 2 years prior to the date of study interview. Data was analyzed for 8251 patients—74.2% men and 25.8% women. Of note, women were significantly older and were more likely to have myocardial ischemia as the recruiting event. Women also had higher use of anti-hypertensive drugs and glucose-lowering medications, which may be explained by the greater burden of comorbidities in women as compared with men; women were more frequently noted to have a history of stroke, hea
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