Gender Differences in Cardiovascular Disease: Perspectives on Disparities in Women’s Treatment and Outcomes – Key Points
10 September 2024
Gender Differences in Cardiovascular Disease: Perspectives on Disparities in Women's Treatment and Outcomes – Key Points
- Women develop CVD later than men. However, this delay does not translate into better outcomes, as women often present with more comorbidities and have a worse prognosis after cardiovascular events
- Risk factors such as diabetes, smoking, and hypertension have differential impacts on men and women. Diabetes increases the risk of CVD more significantly in women than in men, and smoking has been shown to be a more potent risk factor for coronary artery disease (CAD) in younger women compared to men of the same age.
- The symptoms and presentation of CVD can differ significantly between genders, with women being more likely to experience underrepresented symptoms, leading to potential delays in diagnosis and treatment and potentially contributing to poorer outcomes.
- Women with CAD often present with microvascular dysfunction rather than with obstructive coronary lesions, which is associated with poorer diagnosis and management. They are more likely to experience non-obstructive myocardial infarction (MI) and have a higher mortality rate after MI than men.
- Women are more prone to coronary artery spasms and spontaneous coronary artery dissection, which require different management approaches than those for traditional obstructive CAD.
- Women are more likely to develop heart failure with preserved ejection fraction (HFpEF), whereas men more commonly present with reduced ejection fraction (HFrEF) Women with heart failure tend to be older at presentation and have a higher prevalence of hypertension and diabetes as contributing factors.
- women with arrhythmias have a higher risk of drug-induced QT prolongation and torsade de Pointes. They also have a higher incidence of atrial fibrillation but, paradoxically, a lower risk of sudden cardiac death than men. The reasons for these differences are multifactorial and include hormonal influences, differences in ion channel expression, and variations in autonomic tone
- Though aortic diseases are less common in women, certain aortic conditions such as type A aortic dissection are more prevalent in women, particularly in older age groups. Women with aortic dissection often present with atypical symptoms, leading to delayed diagnosis and treatment
- Women have a higher lifetime risk of stroke and often present with more severe strokes than men as well as with atypical symptoms. Unique risk factors for stroke in women include pregnancy, the use of oral contraceptives, and hormone replacement therapy. Moreover, women are more likely to experience certain stroke subtypes such as subarachnoid hemorrhage and cerebral venous thrombosis.
- Women are more susceptible to adverse drug reactions and may require different dosing strategies for certain cardiovascular medications. For instance, women have a higher risk of bleeding with anticoagulant therapy and may derive greater benefits from certain antihypertensive medications. The reasons for these differences include variations in body composition, drug metabolism, and hormonal effects on pharmacokinetics and pharmacodynamics.
- Women with CVD have shown better long-term outcomes under certain conditions. However, they also face unique challenges such as a higher risk of heart failure following MI and increased mortality after coronary artery bypass grafting
