Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2020 May 5;9(9):e014733.
doi: 10.1161/JAHA.119.014733. Epub 2020 May 4.

Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis

Roos E M van Oosterhout  1 , Annemarijn R de Boer  1   2 , Angela H E M Maas  3 , Frans H Rutten  1 , Michiel L Bots  1 , Sanne A E Peters  1   4
Affiliations
Meta-Analysis

Sex Differences in Symptom Presentation in Acute Coronary Syndromes: A Systematic Review and Meta-analysis

Roos E M van Oosterhout et al. J Am Heart Assoc. .

Abstract

Background Timely recognition of patients with acute coronary syndromes (ACS) is important for successful treatment. Previous research has suggested that women with ACS present with different symptoms compared with men. This review assessed the extent of sex differences in symptom presentation in patients with confirmed ACS. Methods and Results A systematic literature search was conducted in PubMed, Embase, and Cochrane up to June 2019. Two reviewers independently screened title-abstracts and full-texts according to predefined inclusion and exclusion criteria. Methodological quality was assessed using the Newcastle-Ottawa Scale. Pooled odds ratios (OR) with 95% CI of a symptom being present were calculated using aggregated and cumulative meta-analyses as well as sex-specific pooled prevalences for each symptom. Twenty-seven studies were included. Compared with men, women with ACS had higher odds of presenting with pain between the shoulder blades (OR 2.15; 95% CI, 1.95-2.37), nausea or vomiting (OR 1.64; 95% CI, 1.48-1.82) and shortness of breath (OR 1.34; 95% CI, 1.21-1.48). Women had lower odds of presenting with chest pain (OR 0.70; 95% CI, 0.63-0.78) and diaphoresis (OR 0.84; 95% CI, 0.76-0.94). Both sexes presented most often with chest pain (pooled prevalences, men 79%; 95% CI, 72-85, pooled prevalences, women 74%; 95% CI, 72-85). Other symptoms also showed substantial overlap in prevalence. The presence of sex differences has been established since the early 2000s. Newer studies did not materially change cumulative findings. Conclusions Women with ACS do have different symptoms at presentation than men with ACS, but there is also considerable overlap. Since these differences have been shown for years, symptoms should no longer be labeled as "atypical" or "typical."

Keywords: acute coronary syndrome; diagnosis; meta‐analysis; sex differences; symptoms; systematic review.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of search results and study selection.
Figure 2
Figure 2
Pooled crude and adjusted odds ratios of symptoms experienced by women relative to men. OR indicates odds ratio.
Figure 3
Figure 3
Results of the aggregated and cumulative meta‐analysis for chest pain as a symptom of ACS in women relative to men summarized in a forest plot. ACS indicates acute coronary syndromes; OR indicates odds ratio.
Figure 4
Figure 4
Results of the meta‐analysis of the pooled prevalence and corresponding 95% CI for all symptoms for ACS in women and men. ACS indicates acute coronary syndromes.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Roth GA, Johnson C, Abajobir A, Abd‐Allah F, Abera SF, Abyu G, Ahmed M, Aksut B, Alam T, Alam K, Alla F, Alvis‐Guzman N, Amrock S, Ansari H, Ärnlöv J, Asayesh H, Atey TM, Avila‐Burgos L, Awasthi A, Banerjee A, Barac A, Bärnighausen T, Barregard L, Bedi N, Belay Ketema E, Bennett D, Berhe G, Bhutta Z, Bitew S, Carapetis J, Carrero JJ, Malta DC, Castañeda‐Orjuela CA, Castillo‐Rivas J, Catalá‐López F, Choi JY, Christensen H, Cirillo M, Cooper L Jr, Criqui M, Cundiff D, Damasceno A, Dandona L, Dandona R, Davletov K, Dharmaratne S, Dorairaj P, Dubey M, Ehrenkranz R, El Sayed Zaki M, Faraon EJA, Esteghamati A, Farid T, Farvid M, Feigin V, Ding EL, Fowkes G, Gebrehiwot T, Gillum R, Gold A, Gona P, Gupta R, Habtewold TD, Hafezi‐Nejad N, Hailu T, Hailu GB, Hankey G, Hassen HY, Abate KH, Havmoeller R, Hay SI, Horino M, Hotez PJ, Jacobsen K, James S, Javanbakht M, Jeemon P, John D, Jonas J, Kalkonde Y, Karimkhani C, Kasaeian A, Khader Y, Khan A, Khang YH, Khera S, Khoja AT, Khubchandani J, Kim D, Kolte D, Kosen S, Krohn KJ, Kumar GA, Kwan GF, Lal DK, Larsson A, Linn S, Lopez A, Lotufo PA, El Razek HMA, Malekzadeh R, Mazidi M, Meier T, Meles KG, Mensah G, Meretoja A, Mezgebe H, Miller T, Mirrakhimov E, Mohammed S, Moran AE, Musa KI, Narula J, Neal B, Ngalesoni F, Nguyen G, Obermeyer CM, Owolabi M, Patton G, Pedro J, Qato D, Qorbani M, Rahimi K, Rai RK, Rawaf S, Ribeiro A, Safiri S, Salomon JA, Santos I, Santric Milicevic M, Sartorius B, Schutte A, Sepanlou S, Shaikh MA, Shin MJ, Shishehbor M, Shore H, Silva DAS, Sobngwi E, Stranges S, Swaminathan S, Tabarés‐Seisdedos R, Tadele Atnafu N, Tesfay F, Thakur JS, Thrift A, Topor‐Madry R, Truelsen T, Tyrovolas S, Ukwaja KN, Uthman O, Vasankari T, Vlassov V, Vollset SE, Wakayo T, Watkins D, Weintraub R, Werdecker A, Westerman R, Wiysonge CS, Wolfe C, Workicho A, Xu G, Yano Y, Yip P, Yonemoto N, Younis M, Yu C, Vos T, Naghavi M, Murray C. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol. 2017;70:1–25. - PMC - PubMed
    1. World Health Organization . Global Health Estimates 2016: Deaths by cause, age, sex, by country and by region, 2000–2016. Geneva: World Health Organization; 2018.
    1. An L, Li W, Shi H, Zhou X, Liu X, Wang H, Liu J, Fan S. Gender difference of symptoms of acute coronary syndrome among Chinese patients: a cross‐sectional study. Eur J Cardiovasc Nurs. 2019;18:179–184. - PubMed
    1. Koopman C, Vaartjes I, Heintjes EM, Spiering W, van Dis I, Herings RMC, Bots ML. Persisting gender differences and attenuating age differences in cardiovascular drug use for prevention and treatment of coronary heart disease, 1998–2010. Eur Heart J. 2013;34:3198–3205. - PubMed
    1. Johansson I, Strömberg A, Swahn E. Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung. 2004;33:291–300. - PubMed

Publication types