Gender considerations in acute coronary syndromes

Gender differences in ACS have been increasingly recognized. Although women are 5–10 years older than men in an ACS population, mortality rates from cardiovascular causes are similar. Risk factors for coronary heart disease appear to be virtually the same in men and women. Gender differences in symptoms associated with an acute MI have been intensively debated. There seem to be some differences but later studies have shown that chest pain is the most frequent symptom in both women and men.

Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, and side effects have been discussed but in the ACS area treatment guidelines make no difference between the genders.

Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. Fewer women than men have been included in cardiovascular trials and consequently the evidence base regarding several treatments is less firm for women. Prospective studies to elucidate whether there are true differences in the effects of different treatment strategies according to gender, and the importance of differences in underlying pathophysiology and comorbidity are strongly needed to identify the most appropriate treatment for men and women respectively.