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Persistent sex differences in outcomes after coronary heart disease: time to move from observation to action
  1. Rabea Asleh
  1. Heart Institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
  1. Correspondence to Dr Rabea Asleh, Heart institute, Hadassah University Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel; rasleh{at}

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Coronary heart disease (CHD) remains a leading morbidity and mortality threat in both men and women, affecting millions of individuals globally. Multiple studies over the last three decades have repeatedly demonstrated significant sex differences in baseline characteristics, clinical presentation and coronary angiographic features, as well as in outcomes across various types of CHD.1 2 Specifically, women presented with first CHD at older age accompanied by a higher prevalence of risk factors and comorbidities compared with men. Studies have consistently demonstrated that the unadjusted outcome of women after acute coronary syndrome is significantly worse than men. This disparity in outcomes was largely attenuated after adjustment for age, comorbidities and other confounders in some, but not all, studies. Women were found to have more angina symptoms despite decreased prevalence of significant epicardial coronary artery disease and ischaemia, and were less likely than men to undergo coronary revascularisation or be treated with guideline-based medical therapies. Moreover, women were found to be at greater risk of procedural complications as well as early and late mortality following coronary revascularisation, with more noticeable differences observed in young women compared with their male counterparts. Despite the increasing awareness of a considerable gap in care and the growing understanding of differences in the pathophysiology of CHD, these disparities in outcomes between men and women persist.

In this issue of the Journal, Akyea and colleagues3 revisit this question in a large retrospective population-based study derived from the UK Clinical Practice Research Datalink GOLD registry of primary care electronic records and provide further insight into the sex disparities in adverse clinical outcomes after incident CHD. These outcomes included recurrent major adverse cardiac events (MACE), defined as the composite of recurrent CHD, any stroke, peripheral vascular disease (PVD), heart failure (HF) or cardiovascular-related mortality (the primary outcome), and the …

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  • Contributors RA was responsible for editorial writing and preparation of the figure and all relevant materials in this article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.

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