Cardiac pharmacologic stress: does the gender matters?

Excerpt

Men and women have differences and similarities. Some of them are easy to determine and to understand. Some are subtler and more difficult to evaluate. The comprehension of these characteristics is very important to better address health care issues. Cardiovascular disease (CVD) is the leading cause of mortality for women globally, accounting for up to one-third of all deaths in women worldwide [1]. Unfortunately, CVD remains understudied, underdiagnosed, and undertreated in women [2]. There are two main aspects to address in this topic: sex differences resulting from biological factors and gender differences related to social, environmental, and community factors [2]. Women present with angina as the first manifestation of coronary artery disease (CAD) more frequently than men. Women have more diverse symptom presentation than do men: with pain or discomfort in jaw, neck, and interscapular area; associated epigastric discomfort and associated nausea, dyspnea, and fatigue [3]. Acute myocardial infarction (AMI) without chest pain is more common in women and the mortality rate is higher than men [3]. Myocardial ischemia in women is more commonly associated with nonobstructive disease of the epicardial coronary arteries, microvascular disease, and coronary vasospasm. This different pathophysiology is not benign. The WISE Study demonstrated an elevated risk of all-cause mortality among women with signs and symptoms of ischemia but without obstructive coronary artery disease (13%) as compared with women of approximately the same age during the same period (2.8%) [4]. Women are less frequently referred for appropriate treatment during an AMI compared with men despite proven mortality benefits of therapy [2]. Figure 1 provides some of the most important characteristics that the cardiologist and nuclear physician must address in the management of women with suspected or know CAD.

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