title: Cardiovascular disease in women: implications for improving health outcomes.
abstract: OBJECTIVE
  To collate data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions.
  
  
  METHODS
  Literature review.
  
  
  RESULTS
  Women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with ST-segment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials.
  
  
  CONCLUSIONS
  Improvement in the prevention and management of CVD in women will require a deeper understanding of women's needs by the community, health care professionals, researchers and government.
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Nursing, Midwifery and Health, University of Technology Sydney, Australia. patriciamary.davidson@uts.edu.au
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Davidson
authors.forename: Julie Anne
authors.initials: JA
authors.lastname: Mitchell
authors.forename: Michelle
authors.initials: M
authors.lastname: DiGiacomo
authors.forename: Sally C
authors.initials: SC
authors.lastname: Inglis
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Newton
authors.forename: Jenni
authors.initials: J
authors.lastname: Harman
authors.forename: John
authors.initials: J
authors.lastname: Daly
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D014943:Global Health; D054625:Healthcare Disparities; D006801:Humans; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012737:Sex Factors; D014932:Women's Health Services