A comprehensive view of sex-specific issues related to cardiovascular disease

• Published in: Canadian Medical Association journal (CMAJ) Vol. 176; no. 6; pp. S1 - S44
• Main Authors: Pilote, Louise, Dasgupta, Kaberi, Guru, Veena, Humphries, Karin H, McGrath, Jennifer, Norris, Colleen, Rabi, Doreen, Tremblay, Johanne, Alamian, Arsham, Barnett, Tracie, Cox, Jafna, Ghali, William Amin, Grace, Sherry, Hamet, Pavel, Ho, Teresa, Kirkland, Susan, Lambert, Marie, Libersan, Danielle, O'Loughlin, Jennifer, Paradis, Gilles, Petrovich, Milan, Tagalakis, Vicky
• Format: Journal Article
• Language: English
• Published: Canada CMA Impact Inc 13-03-2007; Canadian Medical Association
• Subjects: Adolescent; Adult; Age Factors; Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Canada - epidemiology; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Care and treatment; Cause of Death; Child; Coronary Disease - diagnosis; Coronary Disease - epidemiology; Female; Health aspects; Heart Failure - diagnosis; Heart Failure - epidemiology; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Patient outcomes; Prevalence; Quality of Life; Risk Assessment; Severity of Illness Index; Sex (Biology); Sex Distribution; Sex Factors; Supplement; Survival Analysis; Women; Canada
• ISSN: 0820-3946; 1488-2329
• DOI: 10.1503/cmaj.051455

Cardiovascular disease (CVD) is the leading cause of mortality in women. In fact, CVD is responsible for a third of all deaths of women worldwide and half of all deaths of women over 50 years of age in developing countries. The prevalence of CVD risk factor precursors is increasing in children. Retrospective analyses suggest that there are some clinically relevant differences between women and men in terms of prevalence, presentation, management and outcomes of the disease, but little is known about why CVD affects women and men differently. For instance, women with diabetes have a significantly higher CVD mortality rate than men with diabetes. Similarly, women with atrial fibrillation are at greater risk of stroke than men with atrial fibrillation. Historically, women have been underrepresented in clinical trials. The lack of good trial evidence concerning sex-specific outcomes has led to assumptions about CVD treatment in women, which in turn may have resulted in inadequate diagnoses and suboptimal management, greatly affecting outcomes. This knowledge gap may also explain why cardiovascular health in women is not improving as fast as that of men. Over the last decades, mortality rates in men have steadily declined, while those in women remained stable. It is also becoming increasingly evident that gender differences in cultural, behavioural, psychosocial and socioeconomic status are responsible, to various degrees, for the observed differences between women and men. However, the interaction between sex-and gender-related factors and CVD outcomes in women remains largely unknown.