Abstract
Gender plays an important role in the pathophysiology, clinical presentation, and outcomes of various medical illnesses. Among those, special interest is directed towards ischemic heart disease, being the most common cause of mortality in the United States and the developed world. The prevalence and pathogenesis of traditional cardiovascular risk factors differ between women and men, including hypertension, diabetes, dyslipidemia, as well as smoking and psychosocial risk factors such as depression, emotional stress, and low socioeconomic status. However, the difference in the pathophysiology of atherosclerosis represents the hallmark of gender-related discrepancies in ischemic heart disease. While men are more likely to have obstructive coronary artery disease (CAD), women have a higher prevalence of endothelial dysfunction, more tendency for vasospasm, lower coronary flow reserve, and higher incidence of plaque erosion than rupture compared with men. These differences are, at least in part, attributed to variations in sex hormones. Not only that gender affects the pathophysiology of CAD, but also impacts the difference in its clinical presentation. Women are more likely to present with atypical symptoms, and hence are more likely to present late or to be misdiagnosed. This has been shown to adversely impact the outcomes of CAD in women compared with men. Further, the utilization of various modalities for the diagnosis of CAD in women may be challenging due to multiple factors including limited exercise capacity, lower sensitivity of exercise-induced changes in electrocardiogram, higher prevalence of single-vessel disease, attenuation artifacts from breast tissue, and the higher likelihood of endothelial dysfunction rather than obstructive CAD. Clinicians should pay special attention to such differences aiming to improve outcomes in women with ischemic heart disease.
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Saad, M., Megaly, M., Romeo, F., Mehta, J.L. (2020). Gender-Related Differences in the Pathogenesis and Diagnosis of Ischemic Heart Disease. In: Ostadal, B., Dhalla, N.S. (eds) Sex Differences in Heart Disease. Advances in Biochemistry in Health and Disease, vol 21. Springer, Cham. https://doi.org/10.1007/978-3-030-58677-5_1
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