Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Atherosclerosis. 2023 Nov;384:117268. doi: 10.1016/j.atherosclerosis.2023.117268. Epub 2023 Sep 1.
Disparities between women and men persist in the diagnosis, treatment, and prognosis of atherosclerotic cardiovascular disease (ASCVD). Despite growing attention to sex-based differences in cardiovascular care, there are continued disparities in short- and long-term outcomes. Such disparities highlight the need to identify pathophysiologic differences in treatment patterns for stable ischemic heart disease, non-ST elevation myocardial infarction (NSTE-ACS), ST-elevation myocardial infarction (STEMI), and myocardial infarction with non-obstructive coronary arteries (MINOCA). The role of age as an effect modifier should also be considered given that young women diagnosed with ACS continue to experience increased rates of in-hospital mortality and major adverse cardiovascular events. Both patient-directed and systems-based approaches remain integral to improve outcomes in cardiovascular care. While inadequate representation of women in clinical trials remains a barrier to the implementation of evidence-based therapies, a growing body of data has established the efficacy and safety of medications in women across acute coronary syndromes. This review seeks to feature existing data on the differential treatment guidelines, care implementation, and cardiovascular outcomes between women and men, highlighting next directions for clinical investigation.
在动脉粥样硬化性心血管疾病（ASCVD）的诊断、治疗和预后方面，男女之间仍然存在差距。尽管越来越关注心血管护理中的性别差异，但短期和长期结果仍存在差异。这些差异突出表明，需要确定稳定型缺血性心脏病、非 ST 段抬高型心肌梗死（NSTE-ACS）、ST 段抬高型心肌梗死（STEMI）和非阻塞性冠状动脉心肌梗死（MINOCA）治疗模式中的病理生理差异。鉴于年轻女性诊断为 ACS 后继续经历更高的住院死亡率和主要不良心血管事件发生率，还应考虑年龄作为效应修饰剂的作用。患者导向和系统导向的方法仍然是改善心血管护理结果的重要组成部分。尽管临床试验中女性代表性不足仍然是实施基于证据的治疗的障碍，但越来越多的数据已经证实了女性在急性冠状动脉综合征中使用药物的疗效和安全性。本综述旨在介绍现有数据，说明男女之间的差异化治疗指南、护理实施和心血管结局，突出临床研究的下一个方向。
