Title : Coronary disease in women
Abstract:
Cardiovascular diseases (CVD) correspond to the main cause of death worldwide in both genders. There was an increase in the prevalence of CVD in the last 30 years in young people aged 15-49 years, of both genders with proportional mortality was higher in women throughout the period from 1990 to 2019. In women, cardiovascular mortality occurs mainly due to ischemic heart disease (DIC) and cerebral vascular disease.Currently, mortality from cardiovascular disease in women is higher worldwide, surpassing cancer. In addiction to traditional risk factors such as diabetes mellitus, high blood pressure, dyslipidemia, inadequate diet, smoking, obesity and physical inactivity, we have risk factors specific to women. They are: autoimune diseases such as reumatoid arthritis, systemic lupus erythematosus, psoriasis(higher prevalence in the female poplulation), polycystic ovary syndrome, breast cancer treatment, cardiometabolic gestatinal disorders, hormone replacement therapy, depression and anxiety (also more prevalent among women). After menopause, the prevalence and mortality from CVD increases. Menopause brings a decline in circulating estrogen levels, which increasing cardiovascular risk due to its effects on adiposity, lipid metabolism and prothrombotic state. Regarding symptoms, women have more frequently atypical symptoms such as isolated epigastric pain, nausea, sensation of gastric fullness, palpitations and isolated dyspneia than make difficult or delay the diagnosis of coronary disease (CAD). 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 artery dissection, microvascular disease, coronary vasospasm and coronary embolism/thrombosis. The physiopatology 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 The USA have the disorder called INOCA- more common in women. CAD in women commonly has less pronounced atherosclerotic burden, including all plaque subtypes. Risk scores are tools that they may underestimate or overstimate risk in certain groups and may overlook risk factors not captured in source popularions. Additional or female-specific risk factors have not been incorporated into any cardiovascular risk assessment tool. This phenomenon knwon as the “gender paradox” can lead to incorrect diagnosis and worse outcome of coronary disease in 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 high morbidity and mortality for them around the world.
