Aggarwal Niti R, Patel Hena N, Mehta Laxmi S, Sanghani Rupa M, Lundberg Gina P, Lewis Sandra J, Mendelson Marla A, Wood Malissa J, Volgman Annabelle S, Mieres Jennifer H
From Division of Cardiovascular Medicine, Department of Medicine and Radiology, the University of Wisconsin School of Medicine & Public Health, Madison (N.R.A.); Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, IL (H.N.P., R.M.S., A.S.V.); Division of Cardiology, Department of Internal Medicine, The Ohio State University, Columbus (L.S.M.); Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA (G.P.L.); Division of Cardiology, The Oregon Clinic, Portland, OR (S.J.L.); Department of Medicine, Division of Cardiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (M.A.M.); Division of Cardiology, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA (M.J.W.); and Department of Cardiology, Hofstra Northwell School of Medicine, Hempstead, New York (J.H.M.).
Circ Cardiovasc Qual Outcomes. 2018 Feb;11(2):e004437. doi: 10.1161/CIRCOUTCOMES.117.004437.
Evolving knowledge of sex-specific presentations, improved recognition of conventional and novel risk factors, and expanded understanding of the sex-specific pathophysiology of ischemic heart disease have resulted in improved clinical outcomes in women. Yet, ischemic heart disease continues to be the leading cause of morbidity and mortality in women in the United States. The important publication by the Institute of Medicine titled "Women's Health Research-Progress, Pitfalls, and Promise," highlights the persistent disparities in cardiovascular disease burden among subgroups of women, particularly women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment. These important health disparities reflect underrepresentation of women in research, with the resultant unfavorable impact on diagnosis, prevention, and treatment strategies in women at risk for cardiovascular disease. Causes of disparities are multifactorial and related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. Lack of awareness in both the public and medical community, as well as existing knowledge gap regarding sex-specific differences in presentation, risk factors, pathophysiology, and response to treatment for ischemic heart disease, further contribute to outcome disparities. There is a critical need for implementation of sex- and gender-specific strategies to improve cardiovascular outcomes. This review is tailored to meet the needs of a busy clinician and summarizes the contemporary trends, characterizes current sex-specific outcome disparities, delineates challenges, and proposes transformative solutions for improvement of the full spectrum of ischemic heart disease clinical care and research in women.
对性别特异性表现的认识不断发展、对传统和新型危险因素的识别能力提高以及对缺血性心脏病性别特异性病理生理学的理解不断深入，已使女性的临床结局得到改善。然而，在美国，缺血性心脏病仍是女性发病和死亡的主要原因。医学研究所发表的重要出版物《女性健康研究——进展、困境与希望》强调了女性亚群体中心血管疾病负担持续存在的差异，尤其是那些因种族、民族、收入水平和教育程度而处于社会不利地位的女性。这些重要的健康差异反映出女性在研究中的代表性不足，从而对有心血管疾病风险的女性的诊断、预防和治疗策略产生不利影响。差异的原因是多方面的，与危险因素患病率、获得医疗服务的机会、循证指南的使用以及社会和环境因素的差异有关。公众和医学界缺乏认识，以及在缺血性心脏病的表现、危险因素、病理生理学和治疗反应方面存在性别特异性差异的现有知识差距，进一步导致了结局差异。迫切需要实施针对性别和性别的策略来改善心血管结局。本综述旨在满足忙碌临床医生的需求，总结当代趋势，描述当前的性别特异性结局差异，阐述挑战，并提出变革性解决方案，以改善女性缺血性心脏病临床护理和研究的各个方面。
