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(Circulation. 2008;118:3-5.)
© 2008 American Heart Association, Inc.

Editorial

Sex Differences in Congenital Heart Disease

Should a Woman Be More Like a Man?

Carole A. Warnes, MD, FRCP

From the Divisions of Cardiovascular Diseases and Pediatric Cardiology, Mayo Clinic, Rochester, Minn.

Correspondence to Carole A. Warnes, MD, Division of Cardiovascular Diseases, 200 1st St SW, Gonda 5–368, Rochester, MN 55905. E-mail warnes.carole@mayo.edu

Key Words: Editorials • complications • heart defects, congenital • epidemiology

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

	Introduction

 
Sex differences in the clinical presentation, diagnosis, and treatment outcomes of cardiac disease have long been recognized. Since the mid-1980s, the total number of deaths from cardiovascular disease has been higher for women than for men. A greater proportion of women (52%) than men (42%) with myocardial infarction die of sudden cardiac death before reaching the hospital, perhaps in part because women tend to have nonspecific prodromal symptoms rather than chest pain and these symptoms are not recognized as being cardiac in origin.¹ Even after acute myocardial infarction, women are 46% less likely to undergo coronary angiography than men, despite accounting for confounders.² Two-thirds of women who suffer a myocardial infarction never completely recover,^3,4 and those who do survive have a 2-fold recurrence of myocardial infarction and mortality during the first year compared with their male counterparts.⁵

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Women with stable angina have higher in-hospital mortality rates⁶ and worse outcomes after coronary interventions, both percutaneous and surgical. Following percutaneous coronary interventions women have higher rates of short- and long-term mortality, cardiac events, and the need for emergency coronary artery bypass grafting. This may relate to the comparatively smaller coronary artery size of women,⁷ although this is unproven.⁸ Higher mortality and complication rates of coronary artery bypass grafting also occur, with women obtaining less functional relief, more frequent hospital readmissions, and lower functional gains than their male counterparts.⁹ Whether some of these sex disparities relate to an autoimmune precursor for atherosclerotic disease remains speculative. Sex-specific differences in C-reactive protein, . . . [Full Text of this Article]