Female sex is associated with significant inequalities in cardiovascular health, including delayed presentation, misdiagnosis, lower rates of evidence-based treatments, and underrepresentation in clinical trials.
Systematic Review
Are there gender-based inequalities in the presentation, treatment, and outcomes of cardiovascular disease between women and men?
This umbrella review confirms undeniable gender-based inequalities in cardiovascular health, with women experiencing delayed presentations, undertreatment, and underrepresentation in clinical trials, highlighting the need for sex-specific clinical guidance.
This umbrella review aims to investigate possible gender-based inequality in cardiovascular health and improve understanding surrounding differing presentations seen in women. Searches of current literature were conducted using Medline; Cochrane; Cumulative Index of Nursing and Allied Health Literature (CINAHL Plus); and PubMed databases. Focusing on systematic reviews and meta-analyses from the last decade, searches were expanded to the publication year of 2000 onwards, to enable a broader review of current practices. Current clinical guidelines were also reviewed. 17 articles were deemed to satisfy the desired criteria and were therefore carried forward to be critically appraised. The articles reviewed were multifactorial; however, they can be grouped into four categories of common focus: risk factors, presentation, treatment, and current research. On critical analysis, 13 reoccurring themes were noted throughout the reviewed articles with each discussed in detail within this review. There is a need to prioritize women in cardiovascular health, through raising awareness, improving prevention (both primary and secondary), reducing delays in presentation, and increasing understanding and recognition of sex differences in symptom presentation, to enable improved diagnosis and treatment along with the standardization of gender-specific clinical guidance. The results are unanimous regarding an undeniable gender-based inequality in cardiovascular health to the detriment of women. With such damning evidence that women are under-represented and indeed undertreated, the time has come now to question whether women should be considered as their own specialty within cardiology and to ultimately raise awareness and ensure women are given the same consideration regarding cardiovascular disease (CVD) risk assessment and treatment, in order to finally remove gender inequality in cardiovascular (CV) health. In order to reverse this disparity, it is clear from the included studies that further research is required to understand the sex differences seen in both the presentation and symptoms of CVD as well as to enable improved treatment of women and the development of sex-specific strategies and clinical guidance to empower clinicians moving forward.
Bosomworth et al. (Mon,) conducted a systematic review in Cardiovascular disease. Female sex vs. Male sex was evaluated on Gender disparities in cardiovascular care and outcomes. Female sex is associated with significant inequalities in cardiovascular health, including delayed presentation, misdiagnosis, lower rates of evidence-based treatments, and underrepresentation in clinical trials.