Гендерная кардиология: клинико-патофизиологические особенности течения основных заболеваний у женщин

Ишемическая болезнь сердца (ИБС) является ведущей причиной смерти как женщин, так и мужчин. Женщины в более старшем возрасте, когда впервые проявляется ИБС, имеют больше сопутствующих заболеваний и, как правило, жалуются на нетипичные симптомы. Смертность и частота госпитализаций при остром инфаркте миокарде выше у женщин. Необходимо отметить, что приверженность к вторичной профилактике у женщин ниже.

Преобладание женского пола отмечается при идиопатической легочной артериальной гипертензии, наследственной легочной гипертензии и связанной с коллагенозами легочной артериальной гипертензией. Однако последние данные европейского регистра COMPERA показали, что гендерные различия исчезают у пациентов в пожилом возрасте и при наличии сопутствующих заболеваний. Рассматривается более частая встречаемость кардиомиопатий среди женщин. Перипартальная кардиомиопатия, связанная с беременностью и родами, и кардиомиопатия Такоцубо, обусловленная психоэмоциональным напряжением, в частности стрессовой ситуацией, определяет дальнейший прогноз женщины. Нарушения ритма объясняются изменением гормонального статуса на фоне беременности, менопаузы или связаны с дебютом основного заболевания.

Сердечная недостаточность обычно поражает оба пола в равной степени, при этом женщины чаще страдают СНсФВ, а мужчины СНнФВ. Классические сердечно-сосудистые, гендерные и социальные факторы риска сердечно-сосудистых заболеваний и сердечной недостаточности имеют иное значение у женщин, чем у мужчин. Необходимо учитывать параметры при ЭхоКГ диагностике у женщин, поскольку размеры сердца у женщин меньше.

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