Acute coronary syndrome by sex: are the differences truly significant?

Introduction Acute coronary syndrome is one of the leading causes of morbidity and mortality in our setting. While management is generally similar in both sexes, differences exist in clinical presentation, prognosis, and response to treatment. This study analyses the clinical, biochemical, and therapeutic differences between men and women, with particular focus on risk factors, cardiovascular events, and lipid-lowering therapy. Materials and Methods A descriptive, retrospective, single-centre study including data from 408 patients diagnosed with ACS over a 12-month period. Clinical characteristics and lipid profiles were collected, as well as ACS type, number and type of affected vessels, left ventricular function, previous events, and lipid-lowering treatment. The significance level was set at p < 0.05. Results Data from 408 patients were analysed, 300 men and 108 women. The study most relevant characteristics are summarised in Table 1. The mean age was slightly higher in women (66.2 ± 12.1 vs 63.6 ± 11; p = 0.037), with fewer being current or former smokers (19.4% vs 32%; p = 0.013 and 25% vs 35.7%; p = 0.043, respectively). Both groups were comparable in other clinical characteristics as hypertension, diabetes mellitus, atrial fibrillation, cerebrovascular disease, chronic kidney disease or peripheral artery disease. Women experienced their first cardiovascular event later (58.9 vs 62.7 years; p = 0.002), despite having higher levels of total cholesterol (170 vs 146 mg/dL; p < 0.001), no-HDL cholesterol (108 vs 130; p < 0,001), LDL cholesterol (94 vs 81 mg/dL; p = 0.001) and triglycerides (128 vs 134 mg/dL; p= 0,04). Lipoprotein (a) concentrations were also higher in this subgroup (median 54 vs 28; p = 0.010). Additionally, women had a higher incidence of single-vessel coronary artery disease. Men exhibited greater involvement of the left anterior descending artery (72.3% vs 60.2%; p = 0.019), whereas women had a higher prevalence of circumflex artery disease (38.9% vs 50%; p = 0.047). Women also had a higher left ventricular ejection fraction (57.2% vs 60.6%; p = 0.032). A lower prescription rate of statins was observed in women (91.7% vs 96.6%; p = 0.036), with a significant difference in the use of high-intensity statins (89.1% in women vs 93.1% in men; p < 0.001). No significant differences were found in the use of ezetimibe, PCSK9 inhibitors, or additional lipid-lowering therapies. Conclusion This subanalysis highlights significant differences between men and women in clinical presentation, lipid profile, and lipid-lowering management. Women tend to be older at the time of their first cardiovascular event and exhibit higher total cholesterol and lipoprotein (a) levels. Despite these findings, high-intensity statins were prescribed less frequently in women. These results underscore the need for personalised therapeutic strategies and increased awareness of cardiovascular risk management in women.Type of ACS by sex Lipid profile by sex