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CHAPTER SUMMARY AND CENTRAL ILLUSTRATION
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Chapter Summary
This chapter highlights the evidence on sex differences in the pathophysiology and clinical presentations of ischemic heart disease (IHD), and identifies significant disparities in primary prevention and both stable and acute management strategies contributing to the often-reported high adverse risk for women. Throughout the 20th century, atherosclerotic cardiovascular disease (ASCVD) was viewed as predominantly a disease of older-aged men, and little information was available regarding its impact on women. Recent decades have witnessed emerging attention to ASCVD in women, with consequent research hypotheses focused on data specific to women. Today, there exists growing evidence on sex differences in prevention, presentation, diagnostic evaluation, management, and clinical outcomes of women compared with men with suspected and known IHD. The gamut of cultural, social, and financial differences among women and men profoundly impact prompt diagnosis, clinical management, and outcomes of at-risk women. Goals for reducing ASCVD risk tailored to women remain underexplored. The role of biology, clinical and population needs of women, and the socioeconomic disparities of females remain sizeable hurdles to effecting changes to the large population of young to older women at risk for ASCVD (see Fuster and Hurst’s Central Illustration).
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Throughout the 20th century, atherosclerotic cardiovascular disease (ASCVD) was viewed predominantly as a disease affecting older men, and limited information was available regarding its impact on women. Recent decades have witnessed emerging attention to ASCVD in women, with consequent research hypotheses focused on data specific to women. Today, there exists burgeoning evidence on sex differences in the prevention, presentation, diagnostic evaluation, management, and clinical outcomes of patients with suspected and known ischemic heart disease (IHD).1–8 This evidence has evolved rapidly but remains incomplete with regard to understanding the biologic basis for sex differences, distinct pathophysiologic alterations, and variability in diagnostic and treatment effectiveness that contribute to the risk for morbid and fatal outcomes of ASCVD among women as compared to men. The gamut of cultural, social, and financial differences among at-risk women and men profoundly impact their prompt diagnosis, clinical management, and outcomes. In this chapter, we will highlight recent research findings on IHD prevention, diagnosis, management, and clinical outcomes for women with stable or acute IHD.
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DEFINING SEX DIFFERENCES
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Sex differences are biologic differences such as genetic and hormonal, and are increasingly acknowledged to exist even at the cellular level.6,9,10 Sex differences in IHD are wide-ranging and include anatomic (eg, size of coronary blood vessels), physiologic (eg, rate of resting coronary blood flow), age-related hormonal, and comorbid factors uniquely impacting women versus men. Importantly, these differences contribute to variations in disease susceptibility and resilience throughout the lifespan of women and men. Although many have used the term sex dimorphism ...