Cardiovascular diseases (CVD) are a clear example where sex and gender play a role not only in the pathogenesis, but also in the clinical manifestation, because of biological differences, sex-specific cardiovascular risk factors (CVRF), different outcomes and mortality. Improved adherence to gender-specific guidelines and adequate inclusion of women in clinical trials are still needed to address disparities in this field.
Cardiovascular (CV) screening and CV score calculation from health care providers must be encouraged particularly in women, because their risk is often underestimated, both by the patient and by the physician. Considering traditional CVRF, diabetes and smoking are considered to induce a greater risk for CVD in women than in men. Hypertension is underdiagnosed in women, and even when it is detected, less than ¼ women have controlled blood pressure values. CVRF specific to women has also been identified, as early menarche, early menopause, premature ovarian failure, polycystic ovary syndrome, endometriosis, or complications during pregnancy (pre-eclampsia, gestational diabetes, gestational hypertension, peripartum cardiomyopathy). Due to the evolving CV health in females and to modifications that occur with advancing age at the menopause, it is imperative to promote CV prevention across all stages of a woman’s life.
Sex-related differences from pathogenesis to manifestation of CVD have been described. The characteristics of atherosclerotic plaques in younger women are more prone to erosion, rather than plaque rupture. Symptoms can also be different, particularly for acute coronary syndrome with less specific symptoms in younger women. When it comes to cardiac rehabilitation (CR), women participate less than men to CR programs and difficulties have been identified in referral, enrollment and adherence, despite the well-described benefits in women after an acute cardiac event, respectively for morbidity, mortality, functional capacity and quality of life. To improve CR participation in women, we need to offer tailored CR programs to women's needs, as well as behavioral models, to increase long-term adherence to healthy lifestyles.
This narrative review aims to underline the role of sex and gender in CVD and summarizes CV prevention, traditional CVRF as well as female-specific risk factors, gender-specific characteristics of CV manifestation and CR in women.
