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Sex Differences in Medical Care after Acute Myocardial Infarction: What Can Be Done to Address the Problem?

ISSN 1745-5057 10.2217/WHE.09.25 © 2009 Future Medicine Ltd Women's Health (2009) 5(4), 339–341 The following questions need addressing: why are women undertreated relative to men? What characteristics make them so different from men when the physician is at the hospital bedside considering treatment? Multiple factors are likely to contribute to the lower use of evidence-based medicine and higher rates of cardiovascular complications among women with ACS. First, women suffering an ACS event tend to present more often with atypical symptoms, such as nausea, vomiting, fatigue, dyspnea and atypical pain locations, compared with men [9]. Second, cardiovascular disease affects women later in their lives. Among patients presenting with a NSTE ACS, the mean age is 62 years for men versus 68 years for women, and for those presenting with a STEMI, the mean age is 57 years for men versus 66 years for women. In addition to older age, women are also more likely to present with more comorbidities than men [4,5,8]. Third, delays in hospital presentation or in symptom recognition ultimately result in delays in diagnosis and effective treatment [4,8]. It has also been hypo thesized that a patient’s sex may influence a physician’s recommendation with respect to cardiac catheteri zation regardless of the patient’s clinical characteristics [2]. Finally, lack of solid data on cardiovascular disease management in women owing to their under-representation in randomized clinical trials (RCT) leaves uncertainty among clinicians regarding the risk–b enefit balance of many treatments [10–12].