Crea Filippo, Battipaglia Irma, Andreotti Felicita
Department of Cardiovascular Science, Catholic University, Rome, Italy.
Department of Cardiovascular Science, Catholic University, Rome, Italy.
Atherosclerosis. 2015 Jul;241(1):157-68. doi: 10.1016/j.atherosclerosis.2015.04.802. Epub 2015 Apr 27.
Ischaemic heart disease (IHD) is the leading cause of death in women as in men, although presentation in women is on average 7-10 years later. Recent temporal trends show declining IHD incidence and mortality among men but not among women. Other gender differences concern the prevalence of underlying mechanisms. Women more frequently than men have nonobstructive epicardial artery disease, nonatherosclerotic spontaneous coronary artery dissection, stress cardiomyopathy, plaque erosion, microvascular dysfunction, and a heavier risk factor burden, even after adjustment for age. Atypical symptoms of IHD are more common in women. The crude outcomes of both chronic and acute coronary syndromes are worse in women than in men, in relation to older age and comorbidities. After adjustments, in-hospital mortality after acute myocardial infarction is reported to remain higher among younger women compared to male peers. Such female vulnerability, in apparent contrast with the delayed average onset and lesser extent of epicardial atherosclerosis, likely reflects gender differences in early presentation, as well as in mechanisms, prevention, diagnosis, comorbidities, management, and response to treatment. Recognition and quality of care of IHD are still not the same for women and men.
缺血性心脏病（IHD）是女性和男性死亡的主要原因，不过女性发病平均比男性晚7至10年。近期的时间趋势显示，男性的IHD发病率和死亡率在下降，而女性则不然。其他性别差异涉及潜在机制的患病率。即使在调整年龄后，女性比男性更常出现非阻塞性心外膜动脉疾病、非动脉粥样硬化性自发性冠状动脉夹层、应激性心肌病、斑块侵蚀、微血管功能障碍以及更重的危险因素负担。IHD的非典型症状在女性中更为常见。与年龄较大和合并症相关，慢性和急性冠状动脉综合征在女性中的粗略结局比男性更差。调整后，据报道年轻女性急性心肌梗死后的院内死亡率仍高于同龄男性。这种女性的易感性与心外膜动脉粥样硬化平均发病延迟和程度较轻明显不同，可能反映了早期表现以及机制、预防、诊断、合并症、管理和治疗反应方面的性别差异。IHD的识别和护理质量在女性和男性中仍然不同。
