Disparities in ST-Elevation Myocardial Infarction Management for the Young Goose and Young Gander

Traditionally, women with coronary heart disease (CHD) have been understudied, underrecognized, and undertreated, with consequently more adverse outcomes than men.1–3 Sex-based differences in CHD outcomes are a compelling basis for enhancing the representation of women in CHD clinical trials. A robust literature specifically identifies that younger women have more adverse outcomes with myocardial infarction and coronary artery bypass graft surgery than do their male peers.4Article see p 1324This has obtained despite the data that, since 2000, there has been a steady decline in cardiovascular mortality for US women, narrowing the gender gap (Figure 1).5 Half of this mortality decline is attributable to improved management of established cardiovascular disease, and the remainder, to preventive interventions. Sex-specific science (evidence) guides management decisions and has translated into these improved cardiovascular outcomes for women over the past decade, yet many important clinical outcomes differ by age, with young women selectively disadvantaged. Since 1984, more women than men continue to die annually of cardiovascular disease. Importantly, in recent years, there has been an increase in cardiovascular mortality for young women, those aged 35 to 54 years, reversing the favorable trend of the past 4 decades.6 Cardiovascular mortality continues to decline, albeit more slowly in women aged 55 to 64, 56 to 64, 65 to 74, 75 to 84, and >85 years (Figure 2).Figure 1. Cardiovascular disease (CVD) mortality trends for males and females (United States: 1979–2011). Reprinted from Mozaffarian et al5 with permission of the publisher. Copyright © 2015, the American Heart Association.Figure 2. Trends in age-specific mortality rates from coronary heart disease. Reprinted from Ford and Capewell6 with permission of the publisher. Copyright © 2007, the American College of Cardiology.This highlights the prescience and creativity of the Variations in …