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(Circulation. 2007;115:2796-2798.)
© 2007 American Heart Association, Inc.

Editorial

Women, Acute Ischemic Heart Disease, and Antithrombotic Therapy

Challenges and Opportunities

Robert A. Harrington, MD

From the Division of Cardiology, Department of Medicine, and the Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.

Correspondence to Robert A. Harrington, MD, Duke Clinical Research Institute, 2400 Pratt St, Room 0311 Terrace Level, Durham NC 27705. E-mail robert.harrington@duke.edu

Key Words: Editorials • ischemia • heart diseases • women • myocardial infarction

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

There now exists an extensive and growing literature examining gender-based differences in the pathobiology, presentation, treatment patterns, and clinical outcomes of ischemic heart disease (IHD). IHD is a dominant mode of death for women,¹ and, for >20 years, more women than men die annually from IHD.² The first manifestation of IHD in women is frequently myocardial infarction or sudden cardiac death.² A better understanding of the spectrum of issues—from pathophysiology through implementation of evidence-based care—among women with IHD is a public health imperative.

Article p 2822

Recently, many observations have converged around a common set of themes in the care of women with IHD, especially acute IHD. Lansky et al³ have pointed out that women with degrees of obstructive coronary artery disease comparable to those of men receive less revascularization. From the Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines (CRUSADE) registry, we know that women presenting with high-risk non–ST-segment–elevation acute coronary syndromes (primarily myocardial infarction) are less likely than men to undergo an early invasive management strategy despite being at a higher baseline risk.⁴ Women with non–ST-segment–elevation acute coronary syndromes are less likely than men to receive recommended evidence-based medications and cardiac procedures, again despite being at higher baseline risk.⁵

However, there are also challenges in evaluating and deciding on treatments for women presenting with acute coronary syndromes. Roe and colleagues⁶ have shown that women presenting with non–ST-segment–elevation acute coronary syndromes have a greater likelihood of nonobstructive disease than . . . [Full Text of this Article]

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Circulation 2007 115: 2789. [Extract] [Full Text]