Generally, men and women are subject to equal clinical and pharmacological treatment. However, studies show that MI continues to be more lethal in women regardless of age and their co-morbidities. In addition, data from clinical trials about management of women with acute coronary syndrome (ACS) are limited as women are under-represented in randomized control trials .
Factors that contribute to increased morbidity and mortality in women include increased co-morbidities such as diabetes, hypertension and hyperlipidemia due to their increased age at the time of presentation. As well, women present with more complications such as re-infarction, strokes, pulmonary edema, shock and cardiac rupture.
Younger women have a higher mortality rate than men of comparable age, since overall event rates are low and women are often under-diagnosed compared to men.
Women are less likely to receive aspirin, beta blockers and statins compared to male. In a European heart study of 3,800 patients, 73% of women were treated with ASA vs. 81% of men and 45% of women received statins vs. 51% of men .
In a study in USA, women were found to have to wait longer than men for examination and ECG in the emergency department.
Studies show that women whose symptoms are similar to men, are less likely to be admitted to a Coronary Care Unit, especially at an older age. Considering that a Coronary Care Unit is one of the potential places for aggressive management and evidence-based therapies, under representation of women to these environments may be a reason for lack of therapeutic success.
2. Jacobs, A.K., Brooks, S.F., Mori, M., Faxon, D.P., Chaitman, B.R., Bittner, V., Mock, M.B., Weiner, B.H., Winston, D.L. et al. (1998) Better Outcome For Women Compared With Men Undergoing Coronary Revascularization A Report From the Bypass Angioplasty Revascularization Investigation (BARI). Circulation, 98: 1279-1285.
3. Blackwell, M., Huckell, V., Turek, M., (2000) The Medical Managment of Acute Coronary Syndromes and Chronic Ischemic Heart Disease in Women. Canadian Cardiovascular Society Consensus Conference, October 2000, 7/1-7/15.