Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Heart. 2019 Nov;105(21):1656-1660. doi: 10.1136/heartjnl-2018-314268. Epub 2019 Jul 17.
Despite an overall reduction in cardiovascular disease (CVD) mortality in the USA, the rate of coronary heart disease and CVD mortality is on the rise in younger women aged 35 to 54 years. This has been attributed to an increasing prevalence of CVD risk factors, which can portend disparate outcomes in women versus men. Women with diabetes and those who smoke have an excess relative risk of CVD when compared with their male counterparts. In addition to these discrepancies in traditional risk factors, a number of clinical conditions unique to women have been shown to increase CVD risks such as pre-eclampsia, gestational diabetes, polycystic ovary syndrome, early menopause and autoimmune diseases. The majority of these sex-specific risk factors can be identified at an early age, allowing for aggressive risk factor modification through lifestyle changes and, in certain patients, medications. The recently published 2018 American College of Cardiology and American Heart Association (ACC/AHA) hypercholesterolaemia and 2019 ACC/AHA primary prevention guidelines reflect this, citing pre-eclampsia, early menopause and autoimmune diseases as 'risk enhancers' that if present may favour initiation of statin therapy in borderline or intermediate risk patients. This comprehensive review addresses both traditional and unique risk factors of CVD in women, as well as sex-specific risk stratification and management options.
尽管美国心血管疾病 (CVD) 死亡率总体下降，但 35 至 54 岁的年轻女性冠心病和 CVD 死亡率呈上升趋势。这归因于 CVD 风险因素的患病率不断增加，这可能预示着女性与男性的结局不同。与男性相比，患有糖尿病和吸烟的女性患 CVD 的相对风险更高。除了这些传统风险因素的差异外，一些与女性特有的临床情况也被证明会增加 CVD 风险，如子痫前期、妊娠糖尿病、多囊卵巢综合征、早绝经和自身免疫性疾病。这些大多数特定于性别的风险因素可以在早期识别，通过生活方式改变和在某些患者中使用药物积极进行危险因素修正。最近发布的 2018 年美国心脏病学会/美国心脏协会 (ACC/AHA) 高胆固醇血症和 2019 年 ACC/AHA 一级预防指南反映了这一点，将子痫前期、早绝经和自身免疫性疾病列为“风险增强因素”，如果存在这些因素，可能有利于在边缘或中危患者中启动他汀类药物治疗。这篇综合综述既涉及女性 CVD 的传统和独特风险因素，也涉及特定于性别的风险分层和管理选择。
