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Sex disparities in myocardial infarction : Biology or bias?
Stehli, Julia Duffy, Stephen J. Burgess, Sonya Kuhn, Lisa Gulati, Martha Chow, Clara Zaman, Sarah
Stehli, Julia
Duffy, Stephen J.
Burgess, Sonya
Kuhn, Lisa
Gulati, Martha
Chow, Clara
Zaman, Sarah
Abstract
Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion—widespread in the community and health care providers—that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where “time is muscle”. Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant—with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?
Keywords
sex discrepancies, myocardial infarction, women, gender discrepancies
Date
2021
Type
Journal article
Journal
Heart, Lung and Circulation
Book
Volume
30
Issue
1
Page Range
18-26
Article Number
ACU Department
School of Nursing, Midwifery and Paramedicine
Faculty of Health Sciences
Faculty of Health Sciences
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled