Gender differences in coronary heart disease in elderly population

Coronary heart diseases (CHDs) represent one of the leading causes of death in developed countries, and particularly in elderly populations. There are several genderspecific differences in the risk factors, presentation, management, and prognosis of CHDs in middle-aged and elderly adults. Elderly women, for example, tend to present with these diseases at an older age compared to men and are characterized by a greater number of risk factors and comorbidities at diagnosis. As far as symptomatic acute coronary syndromes are concerned, older women are less likely to report critical arterial obstruction, but seem to be more frequently affected by adverse outcomes and higher mortality. These features, which need to be considered during the management of coronary artery diseases in clinical practice, often lead to a lower rate of diagnostic investigations and less invasive therapeutic strategies for females compared to males. Some have hypothesized that the clinical approach toward CHDs in older women may be affected by a biased view due to the scarcity of literature involving women and elderly patients. The misperception that women have a lower cardiovascular risk compared to men and the fact that fewer older people were enrolled in the first large clinical trials have, in fact, led to under-recognized and under-treated CHDs in these patient groups. As most recent studies have considered middle-aged and elderly adults together, it is hard to know if the variability observed in the CHDs’ features is attributable to gender or to advanced age. Gender-and age-related differences in the characteristics and outcomes of CHDs represent therefore a field requiring further investigation to improve the management of such diseases in the elderly population. © 2017, Il Pensiero Scientifico Editore s.r.l.. All rights reserved.