Cardiovascular disease in women: Do we need new diagnostic and therapeutic strategies?

Cardiovascular disease (CVD) is the leading cause of death worldwide affecting both genders equally. However, in comparison to men, in women it often is underrecognized and undertreated in both the primary and secondary prevention settings. It is clear, that in the healthy population, there are profound differences both anatomically and biochemically between woman and men and this may impact how both groups present when they become ill. Therefore, there are some diseases that affect more frequently in women than in men such us myocardial ischemia or infarction without obstructive coronary disease, Tako-subo syndrome, some atrial arrhythmias or the appearance of heart failure with preserved ejection fraction. Therefore, the diagnostic and therapeutic strategies that have been established based largely on clinical studies with a predominant male population must be adapted before being applied to women. There is a paucity of data regarding cardiovascular disease in women. It is inadequate to only perform a subgroup analysis evaluating a specific treatment or invasive technique, when women constitute fifty percent of the population. In this regard, this may affect the time of clinical diagnosis and severity assessments of some valvulopathies. In this review, we will focus on the differences in the diagnosis, management, and outcomes of woman with the most frequent cardiovascular pathologies including coronary artery disease, arrythmias, heart failure and valvopathies. In addition, we will describe diseases that exclusively affect to women related with the pregnancy some of them are life treating. Although the lack of research in women plays a role in the poorer outcomes in women specially in ischemic heart disease the results of some techniques such as transcathether aortic valve implantation and transcatheter edge to edge therapy seem to have better outcome in women.