Gender differences in the treatment of chronic ischemic heart disease: prognostic implications

Abstract

Stable angina is a common presentation of coronary artery disease (CAD), a condition that has an important effect on patients' quality of life and survival. Although women are affected by CAD to a significant extent, the vast majority of observational and epidemiological studies, randomized trials, and clinical guidelines, have for many years focused mainly on males. In the past few years, however, as a result of studies assessing healthcare provision in men vs. women, the focus has gradually shifted to include also women. Observations have been reported in recent years that have identified the existence of inequalities [1,2] regarding management of CAD, which have resulted in women [3] having less access to effective interventions compared with men. This article assesses the evidence available in relation to gender related differences in health care provision in the context of CAD. C O M P A R A T I V E S T U D I E S I N M E N V S . W O M E NThere have been only few large-scale epidemiological investigations and intervention trials in women with stable angina pectoris. Information regarding prognosis in stable angina is similarly scarce and data in this regard are primarily based on studies in male populations. Studies in the primary care setting, as well as Framingham [4] have suggested both that CAD is a condition that afflicts primarily men and that women with angina pectoris have a better prognosis than men with angina. Other studies [5,6] however have shown a higher risk of complications and recurrent events in women undergoing coronary by-pass surgery and percutaneous coronary intervention (PCI) compared with men. Despite the higher incidence of stable angina in women compared with men, there is little information regarding the effects of treatment in women. The majority of studies of secondary prevention and those assessing the effects of pharmacotherapy have been conducted in men.In recent years, several centers have reported gender differences in the diagnosis and treatment of CAD. Interestingly, studies [1][2][3]7] have shown controversial results and could not therefore give a conclusive answer to the question as to whether men and women differ regarding form of presentation, prognosis and response to treatment.

Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry

“…6,39 It remains possible that while women with CAD tend to have less severe coronary obstructive disease than men 31 —and therefore possibly a better outcome—this may be balanced by the more severe outcomes of non-obstructive CAD among women. 43 The known gender bias in diagnosis and access to diagnostic interventions, as found in CLARIFY and elsewhere, 9,14,44,45 is likely to modify long-term prognosis. Although the present study did not explore appropriateness for interventions, there are no data to support reduced efficacy of optimal medical therapy or revascularization in women.…”

“…Although the present study did not explore appropriateness for interventions, there are no data to support reduced efficacy of optimal medical therapy or revascularization in women. 45 …”

Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016–2018

“…They pointed out that despite the relatively high prevalence of coronary artery disease in women, there were little data on the investigation and treatment of ischaemic heart disease in this population. 45 Besides, we found that the proportions increased and the rankings rose with age for both men and women for ischaemic heart disease, cerebrovascular sequelae and other diseases, whereas the proportion decreased and the ranking dropped with age for acute upper respiratory infection. The prevalence of upper respiratory infection decreased with age in the study conducted by Zhang and Shi from 2008 to 2012.…”

Treatment strategies for chronic stable angina

“…Women with chronic stable angina are also less likely to receive treatments such as aspirin, statins and ACE inhibitors, even if recommended in current guidelines [74]. The disparity in investigation and treatment can, in part, be attributed to the sex differences in clinical presentation and distribution of disease [75,76]. Women have a higher prevalence of angina but symptomatic women undergoing coronary angiography have less extensive and severe obstructive CAD.…”