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  • Review Article
  • Published:

Acute coronary syndromes in women and men

Nature Reviews Cardiology volume 13, pages 471–480 (2016)Cite this article

Subjects

Key Points

  • Women and men with acute coronary syndrome (ACS) tend to present with a similar constellation of symptoms, although at different rates

  • Women often have alternative mechanisms of ACS, such as spontaneous coronary artery dissection and vasospasm, beyond the plaque rupture most typically seen in men

  • Across the range of ACS, women generally receive less-aggressive invasive and pharmacological care than men

  • Sex-related outcomes after ACS vary by age; young women have worse short-term and long-term outcomes than men, but old women have similar outcomes to those of old men

  • Representation of women in clinical cardiovascular trials needs to increase in order to address the plethora of unknowns that remain about sex-related differences in ACS

Abstract

Evidence of sex-related disparities in the care and outcomes of patients with acute coronary syndrome (ACS) emerged >30 years ago, and yet the mechanisms behind these sex-specific differences remain unclear. In this Review, we discuss the current literature on differences between women and men in the clinical presentation, pathophysiology, evaluation, management, and outcomes of ACS. Although the symptoms of ACS and the benefits of therapy generally overlap between women and men, women continue to receive less-aggressive invasive and pharmacological therapy than men. In addition, young women in particular have worse short-term and long-term outcomes than men. To understand better the mechanisms behind these continued disparities, we have identified areas of future research that need to be urgently addressed in fields that range from clinical evaluation and management, to increasing representation of women in research.

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Figure 1: Sex-specific differences in baseline risk factors for ACS.
Figure 2: Sex-specific differences in the pathophysiology of acute coronary syndrome.

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  1. Duke Clinical Research Institute, 2400 Pratt Street, Durham, 27705, North Carolina, USA

    Neha J. Pagidipati & Eric D. Peterson

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N.J.P. researched data for the article. N.J.P. and E.D.P. contributed to the discussion of content, wrote the manuscript, and reviewed and edited the manuscript before submission.

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Correspondence to Eric D. Peterson.

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Pagidipati, N., Peterson, E. Acute coronary syndromes in women and men. Nat Rev Cardiol 13, 471–480 (2016). https://doi.org/10.1038/nrcardio.2016.89

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