Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Abstract

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both sexes equally. However, in comparison to men, in women, it often is underrecognized and undertreated in both primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between women and men, and this may impact how both groups present when they become ill. Moreover, some diseases affect more frequently women than men such as myocardial ischemia or infarction without obstructive coronary disease, Takotsubo syndrome, some atrial arrhythmias, or heart failure with preserved ejection fraction. Therefore, diagnostic and therapeutic strategies that have been established largely on the basis of clinical studies with a predominantly male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes for women with the most frequent cardiovascular pathologies including coronary artery disease, arrhythmia, heart failure, and valvopathies. In addition, we will describe diseases that exclusively affect women that are related to pregnancy, and some of them are life-threatening. Although the lack of research on women plays a role in the poorer outcomes in women, especially in ischemic heart disease, some techniques such as transcatheter aortic valve implantation and transcatheter edge-to-edge therapy seem to have better outcomes in women.