Rosenfeld Anne G
Oregon Health and Science University, Portland, OR 97239, USA.
Am J Crit Care. 2006 Nov;15(6):556-66; quiz 567.
Cardiovascular disease is the No. 1 killer of women in the United States, and marked disparities in cardiovascular health exist between women and men and among groups of women. Coronary heart disease is underdiagnosed, undertreated, and under-researched in women. Women with suspected heart disease are less likely than men to receive indicated diagnostic tests and procedures; sex-based biases in treatment of myocardial infarction persist; and women continue to be underrepresented in cardiovascular research. An accumulating body of literature points to 3 major explanations: sex-based physiology, provider bias, and psychosocial influences. Women's acute and prodromal signs and symptoms of myocardial infarction have been described, yet women have difficulty recognizing and acting on these indications. Primary and secondary prevention of heart disease in women is imperative; although the science is lacking in several areas, existing evidence on diet, hormone therapy, aspirin, physical activity and obesity, and diabetes can serve as the basis for interventions. Potentially, large impacts could be made on women's morbidity and mortality if current scientific knowledge were implemented. The state of the science of women and heart disease is reviewed, with a focus on those areas with the greatest potential to address the needs of women's cardiovascular status. Key gaps in the science and remaining questions are presented as a research agenda for the coming decade.
心血管疾病是美国女性的头号杀手，女性与男性之间以及不同女性群体之间在心血管健康方面存在显著差异。冠心病在女性中存在诊断不足、治疗不足和研究不足的情况。疑似患有心脏病的女性比男性接受指定诊断测试和程序的可能性更小；在心肌梗死治疗中基于性别的偏见依然存在；而且女性在心血管研究中的代表性仍然不足。越来越多的文献指出了三个主要原因：基于性别的生理因素、医疗服务提供者的偏见以及社会心理影响。女性心肌梗死的急性和前驱症状已被描述，但女性难以识别这些症状并据此采取行动。女性心脏病的一级和二级预防势在必行；尽管在几个领域缺乏相关科学依据，但关于饮食、激素疗法、阿司匹林、体育活动与肥胖以及糖尿病的现有证据可作为干预措施的基础。如果实施当前的科学知识，可能会对女性的发病率和死亡率产生重大影响。本文对女性与心脏病的科学现状进行了综述，重点关注那些最有潜力满足女性心血管健康需求的领域。文中提出了科学领域的关键差距和遗留问题，作为未来十年的研究议程。
