In a scientific statement published in Circulation, the American Heart Association addresses the presentation, diagnosis, management, and outcomes of acute coronary syndrome in premenopausal women. The statement emphasizes that, although premenopausal women have historically been perceived as being at lower cardiovascular risk, acute coronary syndrome does occur in this population. Studies reviewed in the statement show that younger women are less likely to receive guideline-directed therapies following acute coronary syndrome,and experience worse clinical outcomes compared with their male counterparts.
“The management of ACS [acute coronary syndrome] in premenopausal women presents numerous unique challenges. The facts that many of the relevant causes of ACS [ie, nonatherosclerotic causes] in premenopausal women are seen less commonly than atherosclerotic CAD [coronary artery disease] in general and that there is a corresponding lack of robust clinical trial data unfortunately mean that clinicians are less certain about the optimal diagnostic and management pathways. Indeed, specific pathways for premenopausal women with ACS have not yet been developed, an issue that this scientific statement has sought to address,” wrote the authors of the American Heart Association (AHA) statement, led by Jason C. Kovacic, MBBS, PhD, of Victor Chang Cardiac Research Institute, Sydney.
Summary of Recommendations
Key points highlighted in the statement include:
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Management should be tailored to the unique pathophysiology in premenopausal women, with emphasis on early diagnosis, a low threshold for invasive angiography when appropriate, and special consideration in pregnant patients.
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Factors that contribute to delays in diagnosis and treatment in the emergency department include misattribution of symptoms to noncardiac causes, variability of symptom phenotypes, implicit gender bias, and underuse of diagnostic tests; the statement notes that systematic interventions and public policy changes may help address these barriers.
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Secondary prevention strategies should account for both traditional cardiovascular risk factors and sex-specific considerations, including current or future pregnancy and lactation.
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Participation in cardiac rehabilitation was associated with improved outcomes and should be encouraged.
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Attention to potential post-ACS depression and anxiety is a recommended component of holistic care.
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Increased patient and clinician awareness and improved representation of women in research may close the knowledge and outcome gaps.
“We trust that this scientific statement serves as a useful guide for clinicians managing premenopausal women with ACS but also as an urgent call to action to drive further research and to address the poorer outcomes that are often seen in these young patients,” the statement authors concluded.
Disclosure: For full disclosures of the statement authors, visit ahajournals.org.
Source:Circulation
