Acute coronary syndrome in women: a new and specific approach is needed
Federica Moscucci, Franco Lavalle, Cecilia Politi, Antonella Campanale, Giovanella Baggio, Susanna Sciomer
Abstract
Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity across Europe particularly in women. Indeed, 47% of women die for CVD compared with 39% of men.1,2 Similarly, women die more frequently than men during acute myocardial infarction (AMI).1,3 Moreover, the well-known improvement of chronic CVD prognosis that occurred in the past 10 years pertains mainly to the male gender. This is possibly linked to the greater adherence to guidelines and secondary prevention programmes reported in males compared with females.4 Several pieces of evidence confirm this gender-related differences in CVD outcome. First of all, AMI mortality is substantially reduced in both sexes.4 Regardless, significant differences persist in outcomes between men and women and specifically in AMI outcome of young female population5 and elderly women (aged >75 years).6 Indeed, De Luca et al.6 in a large retrospective data set of patients with acute coronary syndrome (ACS) with 1 000 965 AMI events, found that proportions of female AMI patients decreased over time from 35.8% to 33.4% (mean annual change of 0.29%; CI: 0.25–0.33%, P<0.0001) but the 1-year mortality rate was higher in women than in males with, apparently, a one-decade gap between the two genders. In brief, AMI younger women have an overall worse prognosis than male patients, compared by age, and the in-hospital mortality is higher in AMI women aged >75 years than among age-matched male patients.7