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Sex disparities continue to characterise the management of non‐ST‐elevation acute coronary syndrome

Carlo Andrea Pivato, Birgit Vogel and Roxana Mehran
Med J Aust || doi: 10.5694/mja2.51253
Published online: 20 September 2021

Women with non‐ST‐elevation acute coronary syndromes remain understudied and undertreated

Ischaemic heart disease is the leading cause of death for women worldwide, and sex‐related disparities continue to characterise its management.1 Despite initiatives addressing this problem, cardiovascular risk in women is still underestimated and guideline recommendations have failed to develop sex‐specific strategies, primarily because women are underrepresented in clinical trials.1,2,3 In particular, sex‐specific pathophysiological mechanisms of ischaemic heart disease have not been fully elucidated; for example, acute coronary syndromes (ACS) are more frequently associated with non‐obstructive coronary artery disease and spontaneous coronary dissection in women than in men.4,5 Further, the symptoms of myocardial infarction may be different in women, and this contributes to its under‐recognition and, ultimately, to delays in appropriate treatment.6

  • Carlo Andrea Pivato1,2,3
  • Birgit Vogel1,2
  • Roxana Mehran1,2

  • 1 Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
  • 2 The Zena and Michael A Wiener Cardiovascular Institute, New York, NY, United States of America
  • 3 Humanitas University, Milan, Italy



Competing interests:

Roxana Mehran has received institutional research grants from Abbott, Abiomed, Applied Therapeutics, Arena, AstraZeneca, Bayer, Biosensors, Boston Scientific, Bristol‐Myers Squibb, CardiaWave, CellAegis, CERC, Chiesi, Concept Medical, CSL Behring, DSI, Insel Gruppe, Medtronic, OrbusNeich, Philips, Transverse Medical, and Zoll; personal fees from ACC, Boston Scientific, California Institute for Regenerative Medicine (CIRM), Cine‐Med Research, Janssen, WebMD, and SCAI; consulting fees (paid to her institution) from Abbott, Abiomed, AM‐Pharma, Alleviant Medical, Bayer, Beth Israel Deaconess, CardiaWave, CeloNova, Chiesi, CSL Behring, Concept Medical, DSI, Duke University, Idorsia Pharmaceuticals, Medtronic, Novartis, and Philips; and has equity (less than 1%) in Applied Therapeutics, Elixir Medical, and STEL, and her spouse has similarly minor equity in CONTROLRAD. She sits on the scientific advisory boards for the American Medical Association and the Cardiovascular Research Foundation (no fee); her spouse sits on the Biosensors scientific advisory board.

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