Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.

中文翻译：

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心血管医学中的性别和性别：急性冠状动脉综合征的表现和结果

尽管近年来出现急性冠状动脉综合征 (ACS) 的女性的健康差异受到越来越多的关注，但女性 ACS 的临床结果仍然比男性更差。女性继续经历更高的患者和系统延迟，并接受较不积极的侵入性治疗和药物治疗。导致 ACS 脆弱性的性别和性别特定变量在很大程度上仍然未知。尽管基线冠状动脉解剖结构和功能存在性别差异，但基于根据过度代表男性人群的实验和临床试验数据建立的指南，女性和男性的治疗方式相同。重要的是，年轻女性的预后尤其不利，而且这一年轻人群中仍有大量未解决的问题。本综述总结了血管生物学、临床表现和 ACS 结局方面性别和性别差异的当代证据。我们进一步讨论了调节女性和男性疾病进程的潜在机制和非传统风险条件，例如未识别的心理社会因素、性别特异性血管和神经应激反应以及表观遗传修饰的潜在影响。