155
Views
7
CrossRef citations to date
0
Altmetric
Review

Differences in coronary artery disease and outcomes of percutaneous coronary intervention with drug-eluting stents in women and men

ORCID Icon & ORCID Icon
Pages 301-312 | Received 18 Jan 2021, Accepted 10 Mar 2021, Published online: 22 Mar 2021

References

  • Timmis A, Townsend N, Gale CP, et al. European Society of Cardiology: cardiovascular Disease Statistics 2019. Eur Heart J. 2020 Jan;41(1):12–85.
  • Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics—2020 update: a report from the American heart association. Circulation. 2020;141:e139–e596.
  • Peña JM, Min JK. Sex-related differences in CAD and plaque characteristics. Nat Rev Cardiol. 2016 Jun;13(6):318–319.
  • Hay SI, Abajobir AA, Abate KH, et al. Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the global burden of disease study 2016. Lancet. 2017;390:1260–1344.
  • Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017 Jul;70(1):1–25.
  • Tannenbaum C, Norris CM, McMurtry MS. Sex-specific considerations in guidelines generation and application. Can J Cardiol. 2019 May;35(5):598–605.
  • Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. EuroIntervention. 2019 Feb;14(14):1435–1534.
  • Knuuti J, Wijns W, Saraste A, et al. 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J. 2020;41:407–477.
  • Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2018;39:119–177.
  • Collet J-P, Thiele H, Barbato E, et al. 2020 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2020 Aug;ehaa575.
  • Levine GN, Bates ER, Blankenship JC, et al. 2015 ACC/AHA/SCAI focused update on primary percutaneous coronary intervention for patients with st-elevation myocardial infarction: an update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention and the 2013 ACCF/AHA guideline for t. Circulation. 2016 Mar;133(11):1135–1147.
  • Fihn SD, Blankenship JC, Alexander KP, et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease. J Am Coll Cardiol. 2014 Nov;64(18):1929–1949.
  • Amsterdam EA, Wenger NK, Brindis RG, et al. AHA/ACC guideline for the management of patients with non–st-elevation acute coronary syndromes. Circulation. 2014;2014:130.
  • Borhani S, Hassanajili S, Ahmadi Tafti SH, et al. Cardiovascular stents: overview, evolution, and next generation. Prog Biomater. 2018;7:175–205.
  • Stramba-Badiale M, Fox KM, Priori SG, et al. Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology. Eur Heart J. 2006 Apr;27(8):994–1005.
  • Sex-Specific TA. Trends in midlife coronary heart disease risk and prevalence. Arch Intern Med. 2009 Oct;169(19):1762.
  • Mehran R, Kini AS. Sex-related outcomes after drug-eluting stent. JACC Cardiovasc Interv. 2010 Dec;3(12):1260–1261.
  • Mikhail GW. Coronary heart disease in women. BMJ. 2005 Sep;331:467–468.
  • Vitale C, Mendelsohn ME, Rosano GMC. Gender differences in the cardiovascular effect of sex hormones. Nat Rev Cardiol. 2009Aug6;6(8):532–542.
  • Me M, Karas RH. The protective effects of estrogen on the cardiovascular system. Epstein FH, editor. N Engl J Med. 1999 Jun;340(23):1801–1811.
  • Jacobs AK. Coronary Intervention in 2009. Circ Cardiovasc Interv. 2009 2;Feb(1):69–78.
  • Rossouw J. Hormones, genetic factors, and gender differences in cardiovascular disease. Cardiovasc Res. 2002 Feb;53(3):550–557.
  • Losordo DW, Kearney M, Kim EA, et al. Variable expression of the estrogen receptor in normal and atherosclerotic coronary arteries of premenopausal women. Circulation. 1994 Apr;89(4):1501–1510.
  • Regitz-Zagrosek V, Oertelt-Prigione S, Seeland U, et al. Sex and gender differences in myocardial hypertrophy and heart failure. Circ J. 2010 Jul;74(7):1265–1273.
  • Skavdahl M, Steenbergen C, Clark J, et al. Estrogen receptor-β mediates male-female differences in the development of pressure overload hypertrophy. Am J Physiol Circ Physiol. 2005 Feb;288(2):H469–H476.
  • Ahmed B, Hl D. Women, Bleeding, and Coronary Intervention. Circulation. 2013 Feb;127(5):641–649.
  • Kornowski R, Lansky AJ, Mintz GS, et al. Comparison of men versus women in cross-sectional area luminal narrowing, quantity of plaque, presence of calcium in plaque, and lumen location in coronary arteries by intravascular ultrasound in patients with stable angina pectoris. Am J Cardiol. 1997 Jun;79(12):1601–1605.
  • Sheifer SE, Canos MR, Weinfurt KP, et al. Sex differences in coronary artery size assessed by intravascular ultrasound. Am Heart J. 2000 Apr;139(4):649–652.
  • Herity NA, Lo S, Lee DP, et al. Effect of a change in gender on coronary arterial size. J Am Coll Cardiol. 2003 May;41(9):1539–1546.
  • Serruys PW, Chevalier B, Dudek D, et al. A bioresorbable everolimus-eluting scaffold versus a metallic everolimus-eluting stent for ischaemic heart disease caused by de-novo native coronary artery lesions (ABSORB II): an interim 1-year analysis of clinical and procedural secondary outcomes from. Lancet. 2015 Jan;385(9962):43–54.
  • Vaccarino V, Badimon L, Corti R, et al. Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors?: position paper from the working group on coronary pathophysiology and microcirculation of the European society of cardiology. Cardiovasc Res. 2011 Apr;90(1):9–17.
  • Saeedi P, Petersohn I, Salpea P, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the international diabetes federation diabetes atlas. Diabetes Res Clin Pract. 2019 Nov;157:107843. 9th edition
  • Buja P, D’Amico G, Facchin M, et al. Gender-related differences of diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents: a real-life multicenter experience. Int J Cardiol. 2013 Sep;168(1):139–143.
  • Giustino G, Redfors B, Mehran R, et al. Sex differences in the effect of diabetes mellitus on platelet reactivity and coronary thrombosis: from the assessment of dual antiplatelet therapy with drug-eluting stents (ADAPT-DES) study. Int J Cardiol. 2017 Nov;246:20–25.
  • Regensteiner JG, Golden S, Huebschmann AG, et al. Sex differences in the cardiovascular consequences of diabetes mellitus. Circulation. 2015 Dec;132(25):2424–2447.
  • Dubey R. Sex hormones and hypertension. Cardiovasc Res. 2002 Feb;53(3):688–708.
  • Barton M, Mr M. Postmenopausal Hypertension. Hypertension. 2009 Jul;54(1):11–18.
  • Di Giosia P, Giorgini P, Stamerra CA, et al. Gender differences in epidemiology, pathophysiology, and treatment of hypertension. Curr Atheroscler Rep. 2018 Mar;20(3):13.
  • Phelps T, Snyder E, Rodriguez E, et al. The influence of biological sex and sex hormones on bile acid synthesis and cholesterol homeostasis. Biol Sex Differ. 2019 Dec;10(1):52.
  • Kannel WB, Cholesterol S. Lipoproteins, and the risk of coronary heart disease. Ann Intern Med. 1971 Jan;74(1):1.
  • Rosenson RS, Brewer HB, Davidson WS, et al. Cholesterol efflux and atheroprotection. Circulation. 2012 Apr;125(15):1905–1919.
  • Marques A, Peralta M, Naia A, et al. Prevalence of adult overweight and obesity in 20 European countries, 2014. Eur J Public Health. 2018 Apr;28(2):295–300.
  • Gerdts E, Regitz-Zagrosek V. Sex differences in cardiometabolic disorders. Nat Med. 2019 Nov;25(11):1657–1666.
  • Radzeviciene L, Ostrauskas R. Smoking habits and type 2 diabetes mellitus in women. Women Health. 2018 Sep;58(8):884–897.
  • O’Neill S, O’Driscoll L. Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies. Obes Rev. 2015 Jan;16(1):1–12.
  • Niccoli G, Sgueglia GA, Cosentino N, et al. Impact of gender on clinical outcomes after mTOR-inhibitor drug-eluting stent implantation in patients with first manifestation of ischaemic heart disease. Eur J Prev Cardiol. 2012 Oct;19(5):914–926.
  • Kunio M, Wong G, Markham PM, et al. Sex differences in the outcomes of stent implantation in mini-swine model. Mofrad MRK, editor. PLoS One. 2018 Jan;13(1):e0192004.
  • Falk E, Nakano M, Bentzon JF, et al. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013 Mar;34(10):719–728.
  • Yahagi K, Davis HR, Arbustini E, et al. Sex differences in coronary artery disease: pathological observations. Atherosclerosis. 2015 Mar;239(1):260–267.
  • Douglas PS, Ginsburg GS. The evaluation of chest pain in women. N Engl J Med. 1996 May;334(20):1311–1315.
  • Mieres JH, Shaw LJ, Arai A, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease. Circulation. 2005 Feb;111(5):682–696.
  • Wenger N. Clinical characteristics of coronary heart disease in women: emphasis on gender differences. Cardiovasc Res. 2002 Feb;53(3):558–567.
  • Ferry AV, Anand A, Strachan FE, et al. Presenting symptoms in men and women diagnosed with myocardial infarction using sex‐specific criteria. J Am Heart Assoc. 2019 Sep;8(17):e012307.
  • Park K E, Richard CC. Prognostic significance of asymptomatic myocardial ischemia in women vs. men. Curr Pharm Des. 2016 Jun;22(25):3871–3876.
  • Kunadian V, Chieffo A, Camici PG, et al. An EAPCI expert consensus document on ischaemia with non-obstructive coronary arteries in collaboration with European society of cardiology working group on coronary pathophysiology & microcirculation endorsed by coronary vasomotor disorders internationa. EuroIntervention. 2021 Jan;16(13):1049–1069.
  • Solimene MC. Coronary heart disease in women: a challenge for the 21st century. Clinics. 2010;65(1):99–106.
  • Sivanesan K, Al’Aref SJ, Min JK, et al. Imaging to assess ischemic heart disease in women. Curr Atheroscler Rep. 2018 Mar;20(3):16.
  • Bairey Merz CN, Mark S, Boyan BD, et al. Proceedings from the scientific symposium: sex differences in cardiovascular disease and implications for therapies. J Women’s Heal. 2010 Jun;19:1059–1072.
  • Greco A, Capodanno D, Angiolillo DJ. The conundrum surrounding racial differences on ischaemic and bleeding risk with dual anti-platelet therapy. Thromb Haemost. 2019 Jan;119(1):9–13.
  • Gurbel PA, Bliden KP, Cohen E, et al. Race and sex differences in thrombogenicity: risk of ischemic events following coronary stenting. Blood Coagul Fibrinolysis. 2008 Jun;19(4):268–275.
  • Breet NJ, Sluman MA, Majpj VB, et al. Effect of gender difference on platelet reactivity. Netherlands Heart J. 2011 Nov;19(11):451–457.
  • Capodanno D, Greco A. Platelet function testing after transcatheter aortic valve implantation. Thromb Haemost. 2018;118(10):1681–1685.
  • Tantry US, Bonello L, Aradi D, et al. Consensus and update on the definition of on-treatment platelet reactivity to adenosine diphosphate associated with ischemia and bleeding. J Am Coll Cardiol. 2013;62(24):2261–2273.
  • Yu J, Mehran R, Baber U, et al. Sex differences in the clinical impact of high platelet reactivity after percutaneous coronary intervention with drug-eluting stents. Circ Cardiovasc Interv. 2017 Feb;10(2):e003577.
  • Capodanno D, Di Maio M, Greco A, et al. Safety and efficacy of double antithrombotic therapy with non–vitamin k antagonist oral anticoagulants in patients with atrial fibrillation undergoing percutaneous coronary intervention: a systematic review and meta‐analysis. J Am Heart Assoc. 2020 Aug;9(16):e017212.
  • Yu J, Baber U, Mastoris I, et al. Sex-based differences in cessation of dual-antiplatelet therapy following percutaneous coronary intervention with stents. JACC Cardiovasc Interv. 2016 Jul;9(14):1461–1469.
  • Movahed MR, Hashemzadeh M, Jamal MM, et al. Decreasing in-hospital mortality of patients undergoing percutaneous coronary intervention with persistent higher mortality rates in women and minorities in the United States. J Invasive Cardiol. 2010 Feb;22(2):58–60.
  • Baber U, Giustino G, Wang T, et al. Comparisons of the uptake and in-hospital outcomes associated with second-generation drug-eluting stents between men and women. Coron Artery Dis. 2016 Sep;27(6):442–448.
  • Pepine CJ, Kerensky RA, Lambert CR, et al. Some thoughts on the vasculopathy of women with ischemic heart disease. J Am Coll Cardiol. 2006 Feb;47(3):S30–S35.
  • Peterson ED, Lansky AJ, Kramer J, et al. Effect of gender on the outcomes of contemporary percutaneous coronary intervention. Am J Cardiol. 2001 Aug;88(4):359–364.
  • Jacobs AK, Johnston JM, Haviland A, et al. Improved outcomes for women undergoing contemporary percutaneous coronary intervention: a report from the national heart, lung, and blood institute dynamic registry. J Am Coll Cardiol. 2002 May;39(10):1608–1614.
  • Mehilli J, Kastrati A, Dirschinger J, et al. Differences in prognostic factors and outcomes between women and men undergoing coronary artery stenting. JAMA. 2000 Oct;284(14):1799.
  • Mehilli J, Kastrati A, Dirschinger J, et al. Sex-based analysis of outcome in patients with acute myocardial infarction treated predominantly with percutaneous coronary intervention. JAMA. 2002 Jan;287(2):210.
  • Berger JS, Sanborn TA, Sherman W, et al. Influence of sex on in-hospital outcomes and long-term survival after contemporary percutaneous coronary intervention. Am Heart J. 2006 May;151(5):1026–1031.
  • Russ MA, Wackerl C, Zeymer U, et al. Gender based differences in drug eluting stent implantation - data from the German ALKK registry suggest underuse of DES in elderly women. BMC Cardiovasc Disord. 2017 Dec;17(1):68.
  • Stefanini GG, Baber U, Windecker S, et al. Safety and efficacy of drug-eluting stents in women: a patient-level pooled analysis of randomised trials. Lancet. 2013 Dec;382(9908):1879–1888.
  • Lansky AJ, Costa RA, Mooney M, et al. Gender-based outcomes after paclitaxel-eluting stent implantation in patients with coronary artery disease. J Am Coll Cardiol. 2005 Apr;45(8):1180–1185.
  • Solinas E, Nikolsky E, Lansky AJ, et al. Gender-specific outcomes after sirolimus-eluting stent implantation. J Am Coll Cardiol. 2007 Nov;50(22):2111–2116.
  • Mikhail GW, Gerber RT, Cox DA, et al. Influence of sex on long-term outcomes after percutaneous coronary intervention with the paclitaxel-eluting coronary stent. JACC Cardiovasc Interv. 2010 Dec;3(12):1250–1259.
  • Onuma Y, Kukreja N, Daemen J, et al. Impact of sex on 3-year outcome after percutaneous coronary intervention using bare-metal and drug-eluting stents in previously untreated coronary artery disease. JACC Cardiovasc Interv. 2009 Jul;2:603–610.
  • Nakatani D, Ako J, Tremmel JA, et al. Sex differences in neointimal hyperplasia following endeavor zotarolimus-eluting stent implantation. Am J Cardiol. 2011 Oct;108(7):912–917.
  • Okkels Jensen L, Thayssen P, Hansen HS, et al. Randomized comparison of everolimus-eluting and sirolimus-eluting stents in patients treated with percutaneous coronary intervention. Circulation. 2012 Mar;125(10):1246–1255.
  • Christiansen EH, Jensen LO, Thayssen P, et al. Biolimus-eluting biodegradable polymer-coated stent versus durable polymer-coated sirolimus-eluting stent in unselected patients receiving percutaneous coronary intervention (SORT OUT V): a randomised non-inferiority trial. Lancet. 2013 Feb;381(9867):661–669.
  • Morice M-C, Mikhail GW, Mauri I Ferré F, et al. SPIRIT Women, evaluation of the safety and efficacy of the XIENCE V everolimus-eluting stent system in female patients: referral time for coronary intervention and 2-year clinical outcomes. EuroIntervention. 2012 Jul;8(3):325–335.
  • Franzone A, Zaugg S, Piccolo R, et al. A randomized multicenter trial comparing the XIENCE everolimus eluting stent with the CYPHER sirolimus eluting stent in the treatment of female patients with de novo coronary artery lesions: the SPIRIT WOMEN study. Andò G, editor. PLoS One. 2017 Aug;12(8):e0182632.
  • Batchelor W, Kandzari DE, Davis S, et al. Outcomes in women and minorities compared with white men 1 year after everolimus-eluting stent implantation. JAMA Cardiol. 2017 Dec;2(12):1303.
  • Stefanini GG, Kalesan B, Pilgrim T, et al. Impact of sex on clinical and angiographic outcomes among patients undergoing revascularization with drug-eluting stents. JACC Cardiovasc Interv. 2012 Mar;5(3):301–310.
  • Yang J, Zhang F, Qian J, et al. Sex-based influence on clinical outcomes after drug-eluting stent implantation in real-world patients: insight from the FOCUS registry. Ann Med. 2017 Apr;49(3):185–195.
  • Dangas GD, Claessen BE, Caixeta A, et al. In-Stent Restenosis in the Drug-Eluting Stent Era. J Am Coll Cardiol. 2010 Nov;56(23):1897–1907.
  • Ndrepepa G, Mehilli J, Bollwein H, et al. Sex-associated differences in clinical outcomes after coronary stenting in patients with diabetes mellitus. Am J Med. 2004 Dec;117(11):830–836.
  • Mehilli J. Gender and restenosis after coronary artery stenting. Eur Heart J. 2003 Aug;24(16):1523–1530.
  • Palmerini T, Biondi-Zoccai G, Della RD, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet. 2012 Apr;379(9824):1393–1402.
  • Tovar Forero MN, Zanchin T, Masdjedi K, et al. Incidence and predictors of outcomes after a first definite coronary stent thrombosis. EuroIntervention. 2020 Jul;16(4):e344–e350.
  • Ten Haaf M, Appelman Y, Wijns W, et al. Frequency of stent thrombosis risk at 5 years in women versus men with zotarolimus-eluting compared with sirolimus-eluting stent. Am J Cardiol. 2016 Oct;118(8):1178–1186.
  • Camaj A, Giustino G, Claessen BE, et al. Effect of stent diameter in women undergoing percutaneous coronary intervention with early- and new-generation drug-eluting stents: from the WIN-DES collaboration. Int J Cardiol. 2019 Jul;287:59–61.
  • Chandrasekhar J, Baber U, Sartori S, et al. Effect of increasing stent length on 3-year clinical outcomes in women undergoing percutaneous coronary intervention with new-generation drug-eluting stents. JACC Cardiovasc Interv. 2018 Jan;11(1):53–65.
  • Ormiston JA, Serruys PW, Regar E, et al. A bioabsorbable everolimus-eluting coronary stent system for patients with single de-novo coronary artery lesions (ABSORB): a prospective open-label trial. Lancet. 2008 Mar;371(9616):899–907.
  • Chang CC, Kogame N, Onuma Y, et al. Defining device success for percutaneous coronary intervention trials: a position statement from the European Association of Percutaneous Cardiovascular Interventions of the European Society of Cardiology. EuroIntervention. 2020 Jan;15(13):1190–1198.
  • Kok MM, Van Der Heijden LC, Sen H, et al. Sex difference in chest pain after implantation of newer generation coronary drug-eluting stents. JACC Cardiovasc Interv. 2016 Mar;9(6):553–561.
  • Richards SH, Anderson L, Jenkinson CE, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev. 2017 Apr 4;CD002902.
  • Greco A, Spagnolo M, Capodanno D. Unmasking psychological reasons of delay in acute coronary syndromes presentation during the COVID‐19 pandemic. Catheter Cardiovasc Interv. 2013 Jun; ahead of print.
  • Iantorno M, Torguson R, Kolm P, et al. Relation of sex and race to outcomes in patients undergoing percutaneous intervention with drug-eluting stents. Am J Cardiol. 2019 Mar;123(6):913–918.
  • Kim H-L, Jang J-S, Kim M-A, et al. Gender differences of in-hospital outcomes in patients undergoing percutaneous coronary intervention in the drug-eluting stent era. Medicine (Baltimore). 2019 May;98(20):e15557.
  • Mehran R, Chandrasekhar J, Davis S, et al. Impact of race and ethnicity on the clinical and angiographic characteristics, social determinants of health, and 1-year outcomes after everolimus-eluting coronary stent procedures in women. Circ Cardiovasc Interv. 2019 Apr;12(4):e006918.
  • Giustino G, Harari R, Baber U, et al. Long-term safety and efficacy of new-generation drug-eluting stents in women with acute myocardial infarction. JAMA Cardiol. 2017 Aug;2(8):855.
  • Baber U, Kini AS, Sharma SK. Stenting of complex lesions: an overview. Nat Rev Cardiol. 2010 Sep;7(9):485–496.
  • Mohamed MO, Polad J, Hildick-Smith D, et al. Impact of coronary lesion complexity in percutaneous coronary intervention: one-year outcomes from the large, multicentre e-Ultimaster registry. EuroIntervention. 2020 Sep;16(7):603–612.
  • Giustino G, Baber U, Aquino M, et al. Safety and efficacy of new-generation drug-eluting stents in women undergoing complex percutaneous coronary artery revascularization. JACC Cardiovasc Interv. 2016 Apr;9(7):674–684.
  • Généreux P, Palmerini T, Caixeta A, et al. Quantification and impact of untreated coronary artery disease after percutaneous coronary intervention. J Am Coll Cardiol. 2012 Jun;59(24):2165–2174.
  • Sheiban I, La SC, Cavallero E, et al. Sex-related differences in patients undergoing percutaneous unprotected left main stenting. EuroIntervention. 2010 Feb;5(7):795–800.
  • Shin E-S, Lee CW, Ahn J-M, et al. Sex differences in left main coronary artery stenting: different characteristics but similar outcomes for women compared with men. Int J Cardiol. 2018 Feb;253:50–54.
  • Takagi K, Chieffo A, Shannon J, et al. Impact of gender on long-term mortality in patients with unprotected left main disease: the Milan and New-Tokyo (MITO) Registry. Cardiovasc Revascularization Med. 2016 Sep;17(6):369–374.
  • Trabattoni D, Gili S, Teruzzi G, et al. A sex-based analysis from the RAIN-CARDIOGROUP VII Study (VeRy thin stents for patients with left main or bifurcation in real life) on left main stenting. J Invasive Cardiol. 2020 Sep;32(9):342–346.
  • Melloni C, Berger JS, Wang TY, et al. Representation of women in randomized clinical trials of cardiovascular disease prevention. Circ Cardiovasc Qual Outcomes. 2010 3;Mar(2): 135–142.
  • Steingart RM, Packer M, Hamm P, et al. Sex differences in the management of coronary artery disease. N Engl J Med. 1991 Jul;325(4):226–230.
  • Mosca L, Barrett-Connor E, Kass Wenger N. Sex/Gender differences in cardiovascular disease prevention. Circulation. 2011 Nov;124(19):2145–2154.
  • Hyun K, Negrone A, Redfern J, et al. Gender difference in secondary prevention of cardiovascular disease and outcomes following the survival of acute coronary syndrome. Heart Lung Circ. 2021 Jan;30(1):121–127.
  • The Yentl HB. Syndrome. N Engl J Med. 1991 Jul;325(4):274–276.
  • Lippi D, Bianucci R, Donell S. Gender medicine: its historical roots. Postgrad Med J. 2020 Aug;96(1138):480–486.
  • Bozkurt B, Hill JA, Al-Khatib SM. Fourth annual go red for women issue. Circulation. 2020 Feb;141(7):499–500.
  • Chieffo A, Hoye A, Mauri F, et al. Gender-based issues in interventional cardiology: a consensus statement from the Women in Innovations (WIN) initiative. EuroIntervention. 2010 Feb;5(7):773–779.
  • Manzo-Silberman S, Piccaluga E, Radu MD, et al. Radiation protection measures and sex distribution in European interventional catheterisation laboratories. EuroIntervention. 2020 May;16(1):80–82.
  • Buchanan GL, Ortega R, Chieffo A, et al. Why stronger radiation safety measures are essential for the modern workforce. A perspective from EAPCI women and women as one. EuroIntervention 2020;16:24–25.

Reprints and Corporate Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

To request a reprint or corporate permissions for this article, please click on the relevant link below:

Academic Permissions

Please note: Selecting permissions does not provide access to the full text of the article, please see our help page How do I view content?

Obtain permissions instantly via Rightslink by clicking on the button below:

If you are unable to obtain permissions via Rightslink, please complete and submit this Permissions form. For more information, please visit our Permissions help page.