Sex differences in the management of patients with acute coronary syndrome: A population-based ecological cross-sectional study in Spain

Ruiz-Nodar, Juan M.; Ferreiro, José Luis; Ribera, Aída; Marsal, Josep Ramón; Acuña, José María García; Bermejo, Rosa Agra; Raposeiras‐Roubín, Sergio; Abu‐Assi, Emad; Cordero, Alberto; Bertomeu-González, Vicente; Piñero, Antonio; Nogales-Asensio, Juan Manuel; Ortuño, Francisco Marín; Esteve‐Pastor, María Asunción; Sánchez, Pedro L.; Fernández‐Avilés, Francisco; Polo, Juan Carlos; Tejedor, Ana Viana; Solé, Albert Ariza; Sanchís, Juan; Sánchez, David Martí; Puentes, Damaris Carballeira; Almendro‐Delia, Manuel; Santás-Álvarez, Melisa; Valls-Serral, Amparo; Lozano, Íñigo; Anguita, Manuel; Cequier, Ángel

doi:10.1016/j.rccl.2020.10.009

Cited by 5 publications

(5 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, they are often underrepresented in large clinical trials [ 23 , 24 , 25 ]. In accordance with previous studies, women in our series were significantly older, and age per se has been shown to be associated with a worse prognosis [ 8 , 9 , 10 ]. A prior history of hypertension, together with higher blood pressure on admission, were both more often found in women, and such factors were associated with better outcomes at the one-year follow-up [ 17 ].…”

Section: Discussionsupporting

confidence: 93%

“…A great number of patients hospitalized for ACS are over 70 years of age, and women account for up to 30–40% of them [ 6 , 7 ]. Previous studies show women presenting with an acute coronary event are usually older, with a worse baseline clinical situation than men [ 8 , 9 , 10 ]. Such issues are associated with a worse prognosis [ 6 , 11 , 12 ], though women less often receive optimal medical therapies or an invasive approach [ 8 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Díez‐Villanueva

Garcı́a-Acuña

Raposeiras‐Roubín

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

show abstract

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Díez‐Villanueva

Garcı́a-Acuña

Raposeiras‐Roubín

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

Section: European Region (Eur)mentioning

confidence: 99%

“…Similar to the Americas, large registries from Western Europe reflect excess mortality and persistent sex-based differences in ACS care among women, with less GDMT and invasive revascularization procedures [ 6 , 14 , 137 , 138 , 139 , 140 ]. Furthermore, reperfusion strategies in women less frequently involved radial access [ 4 , 6 , 14 ], thrombo-aspiration [ 14 ] and drug-eluting stent (DES) implantation [ 139 ]. Even among NSTEMI patients at the highest risk of ischemic complications, women were less likely to receive invasive management; even when they did receive an invasive strategy, consistent delays were observed compared with men [ 4 ].…”

Section: European Region (Eur)mentioning

confidence: 99%

“…Even among NSTEMI patients at the highest risk of ischemic complications, women were less likely to receive invasive management; even when they did receive an invasive strategy, consistent delays were observed compared with men [ 4 ]. Furthermore, despite older age and unfavorable risk profile, female ACS patients seem to be sub-optimally treated with P2Y12 inhibitors [ 139 ].…”

Section: European Region (Eur)mentioning

confidence: 99%

See 1 more Smart Citation

Sex Differences in Acute Coronary Syndromes: A Global Perspective

Cader

Banerjee

Gulati

2022

JCDD

View full text Add to dashboard Cite

Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.

show abstract