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(Circulation. 2004;109:565-567.)
© 2004 American Heart Association, Inc.

Focused Perspectives

Acute Coronary Syndrome

The Risk of Being Female

Albrecht Elsaesser, MD; Christian W. Hamm, MD

From the Kerckhoff Heart Center, Bad Nauheim, Germany.

Correspondence to Christian W. Hamm, MD, Kerckhoff Heart Center, Benekestrasse 2-8, 61231 Bad Nauheim, Germany. E-mail christian.hamm@kerckhoff.med.uni-giessen.de

Key Words: Focused Perspectives • women • coronary disease • biological markers

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Coronary heart disease is the leading cause of mortality and morbidity in industrialized countries, in men as well as in women. Women have their first cardiac event 6 to 10 years later than men do. Whereas the cardiovascular death rates are declining in men, they remain constant in women. In cardiovascular studies with age limits, women are naturally the minority, amounting to <40%. It is well known that distinct gender differences exist in terms of presentation of symptoms, validity of diagnostic tests, drug side effects, and complications. With respect to cardiac risk factors, women have higher rates of diabetes and hypertension but are less frequently smokers.

See p 580

Women with acute coronary syndrome (ACS) call later for professional help and present more frequently with atypical symptoms, such as abnormal pain locations, nausea, vomiting, fatigue, and dyspnea. We can only speculate on the reasons for these differences, but they could be related to different pain perception, older age, or other comorbidities. ECG as the first-line diagnostic tool in ACS is also less reliable in females presenting to emergency rooms. There are less frequent ST elevations and higher rates of ST depressions and T-wave inversions, as well as nonspecific alterations.

The type of ischemic event shows gender-specific differences. According to studies such as GUSTO IIb (Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes),¹ TIMI IIIB (Thrombolysis In Myocardial Infarction),² and the Euro Heart Survey,³ women present more frequently with unstable angina and non–ST-elevation myocardial infarction (NSTEMI), . . . [Full Text of this Article]

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Circulation 2004 109: 580-586. [Abstract] [Full Text]

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