Title : Coronary disease in women
Abstract:
Cardiovascular diseases (CVD) correspond to the main cause of death worldwide in both sexes. 1/3 of deaths from all causes affects men and women in all age groups. They represent more than bouble the number of deaths from all neoplas associated. Increase in the prevalence of CVD in the last 30 years in young people aged 15-49 years, of both sexes with proportional mortality, CVD was higher in women throughout the period from 1990 to 2019. In women, cardiovascular mortality occurs mainly due to ischemic disease heart (DIC) and cerebralvascular disease. CVD represents 56% of mortality among womens. Currently, mortality from cardiovascular disease in women is higher worldwide , suropassing cancer. In recente years, the progressive increase in obesity and all diseases related to this condition has fueled in increase in cardiovascular disease worldwide. In addition to traditional risk factors such as diabetes mellitus, high blood pressure, dyslipidemia, inadequate diet, smoking, obesity physical inactivity, we have risk fator specific to women. They are: autoimune diseases such us reumadoid arthritis, systemic lúpus erythematosus, psoriasis(higher prevalence in the female poplulation), polycystic ovary syndrome, brest cancer treatment, cardiometabolic gestatinal disorders, hormone replacement therapy, depression and anxiety (also more prevalent among womens). After menopause, the prevalence and mortality from CVD has increase. Menopause brings a decline in circulating estrogen levels, which increase cardiovascular risk due to its effects on adiposity, lipid metabolism and prothrombotic state. Regarding symptoms, women more frequently have atypical symptoms such as isolated epigastric pain, nausea, sensation of gastric fullness, palpitations and isolated dyspneia than make CAD difficult or delay diagnosis. Studies show that dispite being the majority of people trated for chest pain, women have a greater risk of not receiving adequate diagnosis and treatment. There are several coronary conditions that cause ischemia, such as myocardil infarction in the absence of coronary artery obstruction (MINOCA), ischemia in the absence of coronary obstruction (INOCA), spontaneous coronary artry dissection, microvascular disease, coronary vasospasm and coronary embolism/thrombosis. The pathophysiology of atherosclerosis shows diferent patterns between women and men due to inherent biological and social diferences. It is estimated that about 3 to 4 million adults in teh USA have the disorder called INOCA- more common in women. CAD in women commonly has less pronounced atherosclerotic burden, incuding all plaque subtypes (calcified plaques, non-calcified plaques and low-attenuation plaques). Risk scores are tools that they may underestimate or overstimate risk in certain groups and may overlook risk factors no captured in source popularions. Additional or female-specific risk factors have nor been incorporated into any cardiovascular risk assessment tool. This phenomenon know as the “gender paradox” can lead to incorrect diagnosis and worse outcome of coronary disease in women. Coronary heart disease treatments are similarly effective in men and women. Some studies show that women tend to receive fewer of these therapies compared to men. Therefore, it’ s essential to have a specific look at women when it comes to coronary disease once it is discharged morbidity and mortality for them around the world.
