Desai Shailesh, Munshi Atul, Munshi Devangi
Consulting Preventive Cardiologist, Above Star Bazaar, Satellite Road, Ahmedabad, India.
Consulting Obstetrician and Gynecologist, Ahmedabad, India.
J Midlife Health. 2021 Jan-Mar;12(1):8-15. doi: 10.4103/jmh.jmh_31_21. Epub 2021 Apr 17.
Even though cardiovascular disease (CVD) kills more women than men each year and remains a leading cause of death in women, it is a common misconception that women are less likely to develop CVD. Considerable sex difference exists between men and women with regard to prevention, investigations, and management of CVD. Coronary artery disease (CAD) is a major contributor to CVD morbidity and mortality and hence is specifically addressed in this article. With an explosive increase in the incidence of conventional risk factors for coronary artery disease in India, there has been an alarming increase in women's coronary events as much as men. A false sense of gender-based protection by estrogen leads to less aggressive and late prevention or management strategies that contribute to women's CAD. Metabolic syndrome (MetS) is an important contributor to future development of CAD and is also an indicator for earlier interventions for prevention. Due to physical inactivity and central obesity, MetS is more prevalent in women, especially postmenopausal. With estrogen loss, menopause marks a critical cardiovascular biological transition, with a significantly increased CVD risk in women aged >55 years. Certain female-specific risk factors, such as history of polycystic ovarian syndrome, pregnancy-induced hypertension, and gestational diabetes, also seem to play an essential role in the development of CVD in later life. Certain vascular and biological factors, such as smaller coronary vessel size, higher prevalence of small vessel disease, and lesser development of collateral flow, also play an important role. This review article is an attempt to provide important information on gender differences in CVD with specific emphasis on CAD.
尽管心血管疾病（CVD）每年导致死亡的女性比男性更多，并且仍然是女性死亡的主要原因，但人们普遍误解女性患心血管疾病的可能性较小。在心血管疾病的预防、检查和管理方面，男性和女性之间存在相当大的性别差异。冠状动脉疾病（CAD）是心血管疾病发病率和死亡率的主要促成因素，因此本文将专门讨论这一问题。随着印度冠状动脉疾病传统危险因素的发病率呈爆发式增长，女性冠状动脉事件的增加与男性一样令人担忧。雌激素带来的基于性别的保护的错误观念导致预防或管理策略不够积极和滞后，从而导致女性患冠状动脉疾病。代谢综合征（MetS）是冠状动脉疾病未来发展的重要促成因素，也是早期预防干预的一个指标。由于缺乏身体活动和中心性肥胖，代谢综合征在女性中更为普遍，尤其是绝经后女性。随着雌激素的流失，更年期标志着一个关键的心血管生物学转变，55岁以上女性患心血管疾病的风险显著增加。某些女性特有的危险因素，如多囊卵巢综合征病史、妊娠高血压和妊娠糖尿病，似乎在晚年心血管疾病的发展中也起着重要作用。某些血管和生物学因素，如冠状动脉较小、小血管疾病患病率较高以及侧支循环发育较少，也起着重要作用。这篇综述文章旨在提供有关心血管疾病性别差异的重要信息，特别强调冠状动脉疾病。
