Title:From Mars to Venus: Gender Differences in the Management and Outcomes of Acute Coronary Syndromes
Volume: 22
Issue: 25
Author(s): Nigel S. Tan and Andrew T. Yan
Affiliation:
Keywords:
Acute coronary syndromes, gender, outcomes, risk stratification, trends.
Abstract: Ischemic heart disease remains a leading cause of morbidity and mortality in
industrialized nations, and contributes substantially to healthcare expenditure worldwide. As
the evidence base in acute coronary syndromes (ACS) has expanded dramatically over decades,
longitudinal data demonstrate improvements in risk factor modification, organization
of healthcare systems, and disease management that have substantially attenuated the adverse
prognosis of both ST-segment elevation myocardial infarction (STEMI) and non-STsegment
elevation ACS (NSTE-ACS). Nevertheless, discrepancies remain between genders,
and women with ACS often sustain worse outcomes than men. In this review, we focus on
the gender and sex-specific commonalities and differences in the pathophysiology, clinical
presentations, diagnosis, and risk stratification of ACS. We highlight available data on the
interactions between gender and efficacy of current pharmacological and interventional
treatment for NSTE-ACS and STEMI. We also examine gender differences in the trends of
clinical outcomes, and possible mechanisms that account for persistent care gaps where future efforts can be
directed.