Acute coronary syndrome (ACS) remains a major cause of morbidity and mortality worldwide. Emerging data indicates that there are relevant sex-specific differences in the pathobiology, clinical presentation, and management of ACS in women and men.
This review article summarises sex and gender differences in patients with coronary artery disease, with a particular focus on INOCA.
The influence of sex – considered to be the biological differences between women and men – and gender – considered to be sociologically constructed differences based on membership in one of the two sex categories – appears to be particularly important for noncommunicable diseases such as type 2 diabetes (T2D) and obesity. Many T2D risk factors are behavioral and greatly, but not only, influenced by gender-related determinants, making them modifiable factors. In this review, we focus on sex-related biological differences in the prevalence of diabetes and its biological risk factors, such as obesity, fat distribution, metabolic syndrome, and glucose homeostasis, with a particular interest in the influence of menopause and pregnancy. Men have had globally a higher prevalence of T2D than women with regional, socioeconomic, and age-related variations. Overall, women tend to be more protected from cardiometabolic diseases before menopause than men. However, hormonal variation during the course of life, particularly during menopause, modifies these risks. Similarly to T2D, there are differences in the prevalence of obesity between women and men that change during the lifespan. The link between obesity and T2D seems to be stronger in women compared to men. Various hormones can impact on glycemic levels and on body fat and their concentrations and effect on metabolic parameters can differ by sex. Understanding and acknowledging sex-related differences in T2DM and its risk factors is important to improve health research and lead to better clinical care and more suitable preventive policies and programs for both women and men.
