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Differences exist in the prevalence of particular forms of cardiovascular disease between women and men. These diseases can also manifest with different symptoms between the sexes, which can lead to underdiagnosis, often in women. Sex-specific considerations and biases are also important in determining the availability and types of treatment received. In this Collection of articles from Nature Reviews Cardiology, we explore the sex-specific differences in the prevalence, symptoms, diagnosis, and treatment of atrial fibrillation, acute coronary syndromes, microvascular dysfunction, ischaemic heart disease, and heart failure.
Measurement of biomarkers is a critical component of cardiovascular care, but sex-specific differences in these markers have not been fully integrated into clinical practice. In this Review, Daniels and Maisel assess the utility of sex-specific cut-off points when measuring cardiac troponins or natriuretic peptides in the diagnosis and prognosis of acute coronary syndrome and heart failure, respectively. They also discuss sex-specific differences in novel cardiovascular biomarkers, such as galectin-3, soluble ST2, and proneurotensin.
Differences between women and men with atrial fibrillation have received far less attention in recent years than sex-specific differences in coronary heart disease and stroke. In this Review, Ko et al. discuss sex-specific differences in the incidence, prevalence, risk factors, and pathophysiology of atrial fibrillation, and the clinical presentation and prognosis of patients with this prevalent arrhythmia.
Women with atrial fibrillation (AF) generally experience worse symptoms, poorer quality of life, and have higher risk of stroke and death than men with AF. In this Review, Ko et al. summarize the evidence on sex-specific differences in the utilization and outcomes of treatments for AF, including rate-control and rhythm-control strategies, and stroke-prevention therapy.
The underlying mechanisms for the continued sex-based disparities in acute coronary syndromes (ACS) remain unclear. In this Review, Pagidipati and Peterson discuss the current evidence for sex-related differences in the clinical presentation, pathophysiology, evaluation, management, and outcomes of ACS, and identify urgent research questions that need to be addressed in areas that range from clinical evaluation and management, to representation of women in clinical research.
In the presence of signs and symptoms of myocardial ischaemia, women are more likely than men to have no obstructive coronary artery disease, but might have a higher burden of coronary microvascular dysfunction. In this Review, Dean et al. discuss the prevalence, presentation, diagnosis, and treatment of coronary microvascular dysfunction, with a particular emphasis on sex-specific differences between women and men.
Important differences exist between women and men in clinical presentation, recognition of symptoms, response to treatment, and outcomes in ischaemic heart disease (IHD). In this Review, Vaccarino et al. discuss the current evidence for sex-related differences in the manifestation of IHD, diagnostic strategy, and approaches to treatment, and identify gaps in the literature that need to be addressed in future research.
Cardiovascular disease (CVD) is an under-recognized major health problem among women in South-East Asia, which is compounded by psychological, social, and cultural issues as well as by misconceptions about the disease. In this Review, leading female cardiologists from South-East Asia discuss the changing prevalence of CVD and cardiovascular risk factors among women in the region. The 'heart health awareness' strategies implemented by governments and national heart associations are reviewed, together with the barriers and challenges to improving women's cardiovascular health in South-East Asia.
The numerous physiological changes that occur during pregnancy can affect the pharmacokinetics of drugs that a woman is receiving, often warranting an alteration in dosage. The well-being of the fetus is a major concern among pregnant women who require treatment for their heart disease. In this Review, Pieper provides an overview of the pharmacokinetic changes in drugs for cardiovascular disease during pregnancy, and how these might affect the fetus.
Dr. Moss and colleagues review data from randomized clinical trials which suggest that important sex-specific differences in the epidemiology and clinical characteristics of patients with heart failure can affect their response to both medical and device therapies.