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Acute coronary syndromes
Gender differences in coronary heart disease
  1. Ramzi Y Khamis1,2,
  2. Tareq Ammari1,
  3. Ghada W Mikhail1
  1. 1National Heart and Lung Institute, Imperial College, London, UK
  2. 2Department of Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Ramzi Y Khamis, National Heart and Lung Institute, Hammersmith Hospital Campus, Imperial College London, London, W12 0HN, UK; r.khamis{at}imperial.ac.uk

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Learning objectives

  • Curriculum sections: 2.8 (Acute Coronary Syndromes) and 2.9 (Chronic Ischaemic Heart disease).

  • Learning objectives: outline the differences in the presentation patterns, clinical characteristics, behavioural characteristics and clinical outcomes relating to gender and coronary heart disease (CHD). This will incorporate the following:

  • Knowledge: understand the benefit of cardiovascular interventions in women in comparison with men in both the acute and chronic presentations of CHD. Delineate the data reflecting the need for more research into women and heart disease, coupled with more patient and physician education.

  • Skills: learn the presentation patterns and gender-specific issues related to patients presenting with CHD.

  • Behaviours and attitudes: discuss the preconceived ideas around gender and heart disease, emphasising the need for enhanced assessment of women with heart disease.

Introduction

The importance of coronary heart disease (CHD) as a disease of both genders tends to be underappreciated, although in 2014 CHD claimed almost three times more lives than breast cancer. Just below one in five male deaths and one in ten female deaths were attributed to CHD. The British Heart Foundation's report in that same year states that CHD by itself is the biggest single cause of death in the UK.1

In general, women with CHD have worse outcomes than their male counterparts when no adjustments are made for other characteristics and comorbidities. Women tend to present with coronary artery disease later in life, and even when they present young they tend to receive less evidence-based treatment than their male counterparts.2

An important question is whether gender per se predisposes to higher cardiovascular risk. Much of the research in this field has been in the setting of acute myocardial infarction (AMI), with conflicting evidence from different studies. Some studies reported that gender is an independent risk factor for worse outcomes,3 while …

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