Sex-specific differences in coronary artery disease risk factors, evaluation, and treatment: Have they been adequately evaluated?

Women constitute a significant, growing proportion of patients at risk for acute coronary events. Analyses of the pathophysiology, prevention, diagnosis, and management of coronary disease in women have been hampered in that most clinical trials have studied predominantly male populations. For example, most diagnostic studies have not accounted for sex-specific differences in prevalence of disease or for confounding factors. Disease management in women has also been guided by outcomes data from mostly male populations. Although a review shows no sex-specific differences in relative risk reduction from treatment, it remains possible that differences exist, given the under-representation of women in trials. Including adequate numbers of women in future trials is important yet costly, because of the larger total sample size required. Nevertheless, continued inquiry is required to answer the questions raised by current investigations.