GENDER DISPARITY IN CORONARY HEART DISEASE: BIAS, BIOLOGY, OR BOTH?
Nanette K. Wenger, M.D.,
Emory University School of Medicine, Atlanta, GA, USA
Cardiovascular disease remains a major cause of mortality for women both in industrialized economies and in developing nations. A stunning improvement has occurred in cardiovascular disease mortality for U.S. women between 2000 and 2010, attributable both to application of evidence-based therapies of established cardiovascular disease and to preventive interventions; these likely derived from research studies of cardiovascular disease in women. Despite these salutatory findings, women remain underrepresented in clinical trials of cardiovascular disease and cardiovascular therapies resulting in substantial gender disparities in preventive interventions, diagnostic procedures, and application of guideline-based therapeutic strategies, with consequent adverse outcomes for women. This presentation explores the potential contributions of gender differences in biologic characteristics and of gender bias in coronary heart disease: in the application of preventive interventions; and the management of stable ischemic heart disease, acute coronary syndromes, myocardial infarction, and myocardial revascularization procedures. Gender-specific basic and clinical cardiovascular research is needed to address these issues, with rigorous application required for the emerging knowledge. These approaches offer promise to improve cardiovascular outcomes for women and are the rationale for gender-based evaluation of pathophysiology, preventive interventions, clinical presentations, and medical and revascularization therapies.