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Editorial
March 30, 2020

Sex Differences in Ischemic Heart Disease—the Paradox Persists

Author Affiliations
  • 1Section of Cardiology, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
JAMA Cardiol. Published online March 30, 2020. doi:10.1001/jamacardio.2020.0819

Over the past 4 decades, numerous studies, including randomized clinical trials1,2 and registry data,3 have reported remarkably consistent sex-based differences in clinical, angiographic, and procedural characteristics as well as in outcomes across the spectrum of ischemic heart disease. Women are older with a higher prevalence of risk factors and comorbid disease, less prior myocardial infarction (MI), fewer revascularization procedures, a higher incidence of heart failure despite preserved left ventricular systolic function, and less extensive epicardial coronary artery disease (CAD) (Figure) yet more symptoms compared with men. Women are treated with fewer evidence-based therapies4 and have worse outcomes, including higher complication and mortality rates. With increasing awareness and interest in these biologic differences (or disparities in care), outcomes in women are improving. However, the paradox between risk factors, the extent of CAD, and the degree of symptoms persists.

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