Sex Differences in Ischemic Heart Disease Advances, Obstacles, and Next Steps

被引：210

作者：

Aggarwal, Niti R. ^{[1
]}

Patel, Hena N. ^{[2
]}

Mehta, Laxmi S. ^{[3
]}

Sanghani, Rupa M. ^{[2
]}

Lundberg, Gina P. ^{[4
]}

Lewis, Sandra J. ^{[5
]}

Mendelson, Marla A. ^{[6
]}

Wood, Malissa J. ^{[7
]}

Volgman, Annabelle S. ^{[2
]}

Mieres, Jennifer H. ^{[8
]}

机构：

[1] Univ Wisconsin, Sch Med & Publ Hlth, Dept Med & Radiol, Div Cardiovasc Med, 600 Highland Ave, Madison, WI 53792 USA

[2] Rush Univ, Med Ctr, Dept Internal Med, Div Cardiol, Chicago, IL 60612 USA

[3] Ohio State Univ, Dept Internal Med, Div Cardiol, Columbus, OH 43210 USA

[4] Emory Univ, Sch Med, Div Cardiol, Dept Med, Atlanta, GA 30322 USA

[5] Oregon Clin, Div Cardiol, Portland, OR USA

[6] Northwestern Univ, Dept Med, Northwestern Mem Hosp, Div Cardiol,Feinberg Sch Med, Chicago, IL 60611 USA

[7] Harvard Med Sch, Massachusetts Gen Hosp, Div Cardiol, Dept Med, Boston, MA USA

[8] Hofstra Northwell Sch Med, Dept Cardiol, Hempstead, NY USA

来源：

CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES | 2018年 / 11卷 / 02期

关键词：

ischemic heart disease; sex differences; women; coronary artery disease; healthcare disparities; cardiovascular diseases; CORONARY-ARTERY-DISEASE; ACUTE MYOCARDIAL-INFARCTION; CARDIOVASCULAR RISK-FACTORS; SYNDROME EVALUATION WISE; ALL-CAUSE MORTALITY; GENDER-DIFFERENCES; CARDIAC REHABILITATION; SYMPTOM PRESENTATION; MICROVASCULAR DYSFUNCTION; SCIENTIFIC STATEMENT;

D O I：

10.1161/CIRCOUTCOMES.117.004437

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex-and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.

引用

页数：14