The prevention, diagnosis and treatment of ischemic heart disease in women

It has been almost a quarter century since the first scientific statement on cardiovascular disease in women was published, yet cardiovascular disease remains the leading cause of death in women. Women often present with atypical symptoms which delays recognition, diagnosis and treatment. The complex interplay of gaps in knowledge, sparse sex-specific outcomes data, and limitations of current guidelines lead women to suffer poorer clinical outcomes, with higher cardiovascular morbidity and mortality. While efforts to increase awareness of differences in the presentation of heart disease in women have improved our ability to evaluate women with ischemic symptoms, sex-specific differences in the pathophysiology of heart disease continue to create diagnostic and therapeutic enigmas. As our knowledge of the differential impact of traditional risk factors in women continues to grow, a paucity of sex-specific outcomes data precludes the implementation of evidence-based interventions into clinical practice. More recently, emerging data on non-traditional risk factors unique to and/or more commonly found in women is also shedding new light on the increased burden of disease among younger women, and is an area for future research and interventions. Ultimately, there remains a need for sex and evidence-based diagnostic and therapeutic strategies to address the variances in disease presentation, pharmacokinetic and pharmacodynamics differences in women compared to men, and to identify prognostic markers that can be targets for long-term monitoring. In the interim, we need to ensure that available resources for anatomic and functional assessments of cardiovascular disease are not underutilized in women. This updated review discusses the current challenges of prevention, diagnosis and treatment of ischemic heart disease in women.