Gender Disparities in Coronary Artery Disease Presentation, Diagnosis and Treatment Outcomes: A Contemporary Analysis

Marco Carbone^*
*Correspondence: Marco Carbone, Department of Cardiology, University of Freiburg, Friedrichstr, 39 79098 Freiburg, Germany, Email:

Keywords

Coronary heart disease • Angina • Diagnostic approaches

Introduction

Coronary artery disease is a prevalent and life-threatening cardiovascular condition characterized by the narrowing of blood vessels that supply the heart. Over the years, research has uncovered gender-based disparities in CAD presentation, diagnosis, and treatment outcomes. These disparities have sparked interest among healthcare professionals, researchers, and policymakers, as they highlight the need to better understand the intricacies of how CAD affects different genders. This article presents a contemporary analysis that delves into the gender-related discrepancies observed in CAD, aiming to shed light on the factors contributing to differences in how the disease is diagnosed and managed between men and women. By uncovering these disparities, healthcare systems can formulate targeted strategies to provide equitable care and improve outcomes for all individuals affected by CAD, regardless of their gender.

A systematic literature review was conducted using electronic databases, including PubMed, MEDLINE, and Google Scholar, to identify relevant articles published between 2010 and 2023. The search strategy utilized a combination of keywords related to coronary artery disease, gender disparities, clinical presentation, diagnosis, and treatment outcomes. Gender disparities in Coronary Artery Disease (CAD) have been an area of growing concern within the medical community. This discussion section examines the implications of the gender disparities in CAD presentation, diagnosis, and treatment outcomes outlined in the earlier sections and explores potential strategies to address these disparities. The observed gender differences in CAD symptom presentation highlight the need for heightened awareness among healthcare providers. Women often experience atypical symptoms that can easily be misattributed to non-cardiac conditions, leading to underdiagnosis and delayed treatment. Raising awareness among both patients and healthcare professionals about the varied ways CAD can manifest in women is crucial to ensuring timely diagnosis and intervention [1-3].

Literature Review

Provider bias, stemming from historical biases in medical research and clinical practices, can contribute to diagnostic disparities. The misconception that CAD primarily affects men can lead to undertreatment of women. Addressing provider bias through education and training can mitigate this issue, fostering unbiased clinical judgment and improving the accuracy of CAD diagnosis across genders. Societal perceptions that CAD is predominantly a male disease can affect women's willingness to seek medical attention promptly. Public health campaigns aimed at dispelling such misconceptions and promoting awareness of CAD risk factors in women can empower individuals to take their symptoms seriously and seek timely medical help.

Disparities in access to healthcare services and diagnostic tests can exacerbate gender-based differences in CAD diagnosis. Women may face longer wait times for diagnostic procedures, hindering timely intervention. Healthcare systems must strive to provide equitable access to diagnostic tests, ensuring that no patient, irrespective of gender, faces unnecessary delays in diagnosis and treatment. Recent studies have reported differences in the clinical presentation of CAD between men and women. Women tend to present with atypical symptoms such as fatigue, shortness of breath, and nausea, which might contribute to underdiagnosis and delayed treatment. In contrast, men often exhibit the classic symptom of chest pain (angina), leading to more prompt recognition and intervention. These differences emphasize the need for heightened awareness of atypical symptoms in women to ensure accurate and timely diagnosis.

Discussion

Diagnostic disparities

Gender disparities also extend to the diagnostic phase of CAD management. Women are often subject to fewer diagnostic tests, such as coronary angiography and stress tests, even when presenting with equivalent symptoms. This underutilization of diagnostic procedures in women may result from stereotypes about CAD being a predominantly male disease, potentially leading to missed opportunities for early intervention.

The treatment landscape for CAD includes medical therapy, percutaneous coronary intervention, and coronary artery bypass grafting. Studies have indicated that women are less likely to receive guideline-recommended therapies and interventions, including revascularization procedures. This discrepancy in treatment may contribute to poorer outcomes among women, including higher rates of post-procedural complications and long-term mortality. Gender disparities in Coronary Artery Disease (CAD) diagnosis are complex and influenced by a combination of biological, social, and healthcare system factors. Understanding these factors is crucial for addressing and reducing the diagnostic discrepancies that exist between men and women [4,5].

Biological differences

Biological dissimilarities between sexes play a role in CAD diagnosis disparities. Women may present with symptoms that are subtler and atypical, which can lead to misinterpretation or delayed diagnosis. Hormonal variations, such as estrogen's potential cardioprotective effects, can also influence the disease's progression and manifestation in women. Socio-cultural factors contribute significantly to gender-based diagnostic disparities. Societal perceptions of CAD as a "male" disease may lead to underestimation of risk in women. This perception can deter women from seeking timely medical attention and may even influence healthcare providers' decision-making processes.

Implicit biases and stereotyping among healthcare providers can impact the diagnostic process. Historically, CAD research has focused predominantly on male patients, leading to a perception that men are at higher risk. This bias can influence healthcare professionals to downplay symptoms in women, potentially resulting in underdiagnosis or delayed diagnosis. Lack of awareness, both among patients and healthcare providers, contributes to diagnostic disparities. Women themselves might not recognize the symptoms of CAD, particularly if they deviate from the commonly associated chest pain. Likewise, healthcare providers may not be attuned to the unique ways in which CAD can manifest in women, leading to missed opportunities for early diagnosis.

Healthcare system-related challenges can also perpetuate diagnostic disparities. Limited access to appropriate diagnostic tests, longer wait times for procedures, and gender-related biases in referral patterns can all hinder timely and accurate diagnosis for women. Historically, clinical trials and research studies have underrepresented women, especially those of diverse ethnic backgrounds [6]. This lack of representation can lead to a knowledge gap regarding how CAD manifests and progresses in women, affecting diagnostic accuracy and management strategies. Women may experience CAD symptoms in ways that are different from the classic pattern, which can lead to misinterpretation by both patients and healthcare providers. Non-specific symptoms, such as fatigue or shortness of breath, can be attributed to other conditions, delaying the recognition of CAD as the underlying cause. Age-related differences in CAD manifestation can further complicate diagnosis. Women typically develop CAD later in life compared to men. As a result, CAD might not be considered as readily in younger women experiencing symptoms, leading to misdiagnosis or delayed diagnosis [6].

Conclusion

Gender disparities in coronary artery disease presentation, diagnosis, and treatment outcomes remain a critical issue in contemporary healthcare. Addressing these disparities requires a multidimensional approach involving increased awareness, education, and training for both healthcare professionals and the general population. Furthermore, healthcare policies need to be revised to ensure equitable access to diagnostic and therapeutic interventions. Ultimately, a comprehensive effort is required to bridge the gender gap in CAD management and improve outcomes for all individuals.

Acknowledgement

None.

Conflict of Interest

Authors declare no conflict of interest.

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