Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the
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WOMEN AND ISCHEMIC HEART DISEASE (P. KOHLI, SECTION EDITOR)
Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap Olivia Manfrini 1 & Edina Cenko 1 & Raffaele Bugiardini 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event. Recent Findings Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. Summary The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient’s body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction. Keywords Women . Ischemic heart disease . Risk factors . Acute myocardial infarction . Gender differences
Introduction In 1991, Bernardine Healy called attention to the discriminatory behavior of cardiologists towards women with underdiagnosed and undertreated ischemic heart disease in a publication in the New England Journal of Medicine entitled “Yentl syndrome.” The term “Yentl Syndrome” has come to be used in medicine to define the possibility that diagnostic and therapeutic strategies are not offered in a similar manner to both men and women [1•]. “The Yentl Syndrome” also served as a call-to-action to increase knowledge regarding heart disease in women. The National Institutes of Health (NIH) established the Women’s Health Initiative to address various chronic diseases that affect women. Concerns about sex disparity in research prompted two US regulation mandates. The first was the requirement that all NIHfunded clinical trials include women and be adequately powered
to perform sex-specific analyses [2]. The second was the Food and Drug Administration requirement that all data analysis be sex specific in pharmaceutical trials [3]. Then, in June 2015, the NIH announced a new policy highlighting the expectation that sex as a biological variable be factored into research designs, analyses, and reporting of vertebrate animal and human studies [4]. Despite the international focus on heart disease in women, significant gaps still persist in sex-specific research and many questions of clinical importance remain unanswered. This review article strongly supports the view that female sex is a biological variabl
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