Cardiovascular disease is the worldwide leading cause of death in women. Biological differences between the sexes resulting from genetic, epigenetic, and sex hormone-mediated factors are complex and not completely understood. Socio-cultural factors compound these differences and together account for the variation in the prevalence, presentation, and natural history of cardiovascular disease between men and women. Although there is growing recognition of sex-specific determinants of outcomes, women remain under-represented in clinical trials, and sex-disaggregated diagnostic and management strategies are not currently recommended in clinical guidelines.
Women remain more likely to experience delays in diagnosis, be treated less aggressively, and have worse outcomes. As a consequence, cardiovascular disease in women remains understudied, underdiagnosed, and undertreated. The April 2021 issue of the journal Anaesthesia will focus on female-specific cardiovascular disease characteristics and how these may impact anesthetic and peri-operative risk assessment and care. It will highlight significant differences between the sexes in the natural history of cardiovascular disease, including those disease entities that are more common in women, such as sudden coronary artery dissection or microvascular dysfunction.
Given the rapidly rising incidence of maternal cardiovascular disease and associated complications, special consideration is given to the risk assessment and management of these conditions during pregnancy. Increased awareness of these issues can improve the effectiveness of the multidisciplinary heart team and ultimately improve the care provided to women.