OCC-WCC 2024丨WCC-女性与心血管健康论坛：聚焦女性心血管健康，共谋2030年减负策略

小龙女 2024-07-03 19:54:39

心血管领域女性问题日益凸显，深入研究和解决心血管领域的女性问题，对于提升女性心血管健康水平至关重要。第十八届东方心脏病学会议&世界心脏病学大会（OCC-WCC 2024）的WCC-女性与心血管健康论坛上，来自南非的Liesl Zuhkle教授、中国的陈韵岱教授、新加坡的Carolyn Lam教授以及世界心脏联盟高级科学顾问Pablo Perel教授，围绕心血管疾病防治过程中涉及的性别差异带来的治疗、康复等内容，带来精彩的主题演讲。

Women's issues in the cardiovascular field are becoming increasingly prominent. In-depth research and solutions to women's issues in the cardiovascular field are crucial to improving women's cardiovascular health. At the WCC-Women and Cardiovascular Health Forum of the 18th Eastern Cardiology Conference & World Congress of Cardiology (OCC-WCC 2024), Professor Liesl Zuhkle from South Africa, Professor Chen Yundai from China, Professor Carolyn Lam from Singapore, and Professor Pablo Perel, senior scientific advisor of the World Heart Federation, delivered wonderful keynote speeches on treatment and rehabilitation caused by gender differences in the prevention and treatment of cardiovascular diseases.

Liesl Zuhlke教授：

实现2030心血管健康愿景，性别差异不容忽视

Liesl Zuhlke教授强调，心血管疾病仍然是全球女性死亡的主要原因，就心血管疾病亚型而言，缺血性心脏病是全球女性心血管死亡的最常见原因。高血压、血脂异常和糖尿病是导致女性心血管死亡的最重要危险因素。针对这些风险因素采取全球性教育、筛查和治疗方法是《柳叶刀》妇女和心血管疾病委员会最重要的优先事项之一。为有效实施这些策略，必须设计并实施基于政策的举措，确保这些措施能够深入女性日常生活的环境，如医疗设施、社区中心和工作场所。此外，委员会也呼吁在人口稠密和工业化地区加强女性心血管疾病的预防、诊断和治疗。这不仅是为了提高整体医疗水平，更为了缩小性别间的健康差异，确保女性能够享受到与男性同等的健康权益。同时，深入研究和理解心血管疾病的性别差异至关重要。为此委员会建议根据全球自愿目标，制定针对特定区域的心血管疾病政策。通过明确公共卫生和社区干预的优先事项、目标和指标，可以更加精准地预防、减少和管理女性心血管疾病，为女性健康构筑更加坚实的防线。

Professor Liesl Zuhlke emphasized that cardiovascular disease remains the leading cause of death among women worldwide. In terms of cardiovascular disease subtypes, ischemic heart disease is the most common cause of cardiovascular death among women worldwide. Hypertension, dyslipidemia and diabetes are the most important risk factors for cardiovascular death in women. Global education, screening and treatment methods for these risk factors are one of the most important priorities of The Lancet Commission on Women and Cardiovascular Disease. To effectively implement these strategies, policy-based initiatives must be designed and implemented to ensure that these measures can reach women's daily living environments, such as medical facilities, community centers and workplaces. In addition, the Commission also called for strengthening the prevention, diagnosis and treatment of cardiovascular disease in women in densely populated and industrialized areas. This is not only to improve the overall level of medical care, but also to narrow the health gap between genders and ensure that women can enjoy the same health rights as men. At the same time, it is crucial to deeply study and understand the gender differences in cardiovascular disease. To this end, the Commission recommends the formulation of cardiovascular disease policies for specific regions based on global voluntary targets. By clarifying the priorities, goals and indicators of public health and community interventions, cardiovascular disease in women can be prevented, reduced and managed more accurately, building a more solid line of defense for women's health.

陈韵岱教授：

QFR引导下PCI治疗临床结果的性别差异研究

陈韵岱教授在分享中指出，FAVOR III中国试验证实，对于接受PCI治疗的患者，与血管造影指导相比，定量流速比（QFR）指导的病变选择策略在1年和2年的临床结果。为进一步探索QFR指导的PCI对男性和女性的益处，陈教授特别分析了QFR与血管造影引导的PCI在性别差异上的临床益处。结果显示，QFR指导的PCI在男性和女性中均显著降低了2年MACE发生率，且两性间QFR值相似。陈教授表示，首次对 QFR 指导的 PCl 的 2 年临床益处的性别差异进行比较的分析研究，结果也与FAME 和 DEFINE-FLAIR 研究的亚组分析结果一致，即男性和女性之间不同治疗策略的 MACE 发生率没有显著差异。但此项研究主要针对中低风险人群，未来仍需针对女性患者开展更广泛的随机对照试验，以充分评估QFR指导的PCI策略的益处。

Professor Chen Yundai pointed out in her sharing that the FAVOR III China trial confirmed that for patients undergoing PCI treatment, the lesion selection strategy guided by the quantitative flow rate ratio (QFR) had better clinical outcomes at 1 and 2 years compared with angiography guidance. To further explore the benefits of QFR-guided PCI for men and women, Professor Chen specifically analyzed the clinical benefits of QFR and angiography-guided PCI in terms of gender differences. The results showed that QFR-guided PCI significantly reduced the 2-year MACE incidence in both men and women, and the QFR values were similar between the two sexes. Professor Chen said that this was the first analytical study to compare the gender differences in the 2-year clinical benefits of QFR-guided PCl, and the results were consistent with the results of the subgroup analysis of the FAME and DEFINE-FLAIR studies, that is, there was no significant difference in the MACE incidence of different treatment strategies between men and women. However, this study mainly targeted low- and medium-risk populations, and more extensive randomized controlled trials will still need to be conducted on female patients in the future to fully evaluate the benefits of the QFR-guided PCI strategy.

Carolyn Lam教授：

心衰中的性别差异：策略与挑战

Carolyn Lam教授指出，心衰在男性和女性中存在显著性别差异，不仅影响流行病学和病理生理，还涉及药物反应和心脏康复效果。一项纳入31项研究的荟萃分析表明，女性HFpEF（射血分数保留的心力衰竭）患病率显著高于男性（37%vs.18%，P＜0.001）。肥胖和更年期是女性HFpEF的重要风险因素。妊娠相关因素也会增加女性HFpEF风险。女性常面临更高的心血管事件风险，如动脉僵硬度和脉压增加，更易发生向心性心室重塑和微血管疾病。药物应用中，女性对美托洛尔等药物反应更显著，需考虑性别差异调整剂量。此外，尽管男女对HFrEF的治疗反应相似，但女性可能需较低剂量的ACE抑制剂。女性心脏康复参与率和粘附率较低，但可能从中获得更大益处。因此，加强女性心脏康复宣传与推广，提升治疗成效，成为当务之急。

Professor Carolyn Lam pointed out that there are significant gender differences in heart failure between men and women, which not only affects epidemiology and pathophysiology, but also involves drug response and cardiac rehabilitation effects. A meta-analysis of 31 studies showed that the prevalence of HFpEF (heart failure with preserved ejection fraction) in women was significantly higher than that in men (37% vs. 18%, P < 0.001). Obesity and menopause are important risk factors for HFpEF in women. Pregnancy-related factors also increase the risk of HFpEF in women. Women often face a higher risk of cardiovascular events, such as increased arterial stiffness and pulse pressure, and are more susceptible to concentric ventricular remodeling and microvascular disease. In drug application, women respond more significantly to drugs such as metoprolol, and the dose should be adjusted considering gender differences. In addition, although men and women have similar treatment responses to HFrEF, women may need lower doses of ACE inhibitors. Women have lower participation and adhesion rates in cardiac rehabilitation, but may benefit more from it. Therefore, it is imperative to strengthen the publicity and promotion of cardiac rehabilitation for women and improve treatment outcomes.

Pablo Perel教授：

急性冠状动脉综合征中的性别差异，亟待关注与研究

Pablo Perel教授在演讲中指出，《柳叶刀》妇女和心血管疾病委员会旨在到2030年减轻全球心血管疾病负担。但对于女性患者，仍面临数据缺失、认识不足、治疗不足等挑战。同时，心血管疾病病理生理学和自然史中的性别特异性机制仍未得到充分了解，女性临床试验代表不足。此外，社会经济贫困是女性心血管疾病全球负担的重要原因，年轻女性心肌梗死和心血管疾病死亡率正在上升。以急性冠状动脉综合征症状表现的性别差异为例，既往研究证实，患者对急性冠脉综合征症状表现的认知度较低，且症状存在性别差异。此外虽然女性接受的侵入性治疗比例较低，但是相比男性有较高的死亡率。一项涉及73 个国家和地区（2/3 高收入国家）、446篇文献，32,875,226 名研究参与者（女性占比中位数为29%）的荟萃分析表明，在 ACS 护理过程中，男性往往能够得到更多益处，在院前和诊断阶段的研究相对较少且性别差异显著。对低中收入国家（LMIC）的研究亦不足，凸显了性别差异在ACS护理中的重要性。

Professor Pablo Perel pointed out in her speech that the Lancet Commission on Women and Cardiovascular Disease aims to reduce the global burden of cardiovascular disease by 2030. However, female patients still face challenges such as missing data, insufficient awareness, and inadequate treatment. At the same time, the gender-specific mechanisms in the pathophysiology and natural history of cardiovascular disease are still not fully understood, and women are underrepresented in clinical trials. In addition, socioeconomic poverty is an important cause of the global burden of cardiovascular disease in women, and the mortality rate of myocardial infarction and cardiovascular disease in young women is rising. Taking the gender difference in the symptoms of acute coronary syndrome as an example, previous studies have confirmed that patients have a low level of awareness of the symptoms of acute coronary syndrome, and there are gender differences in symptoms. In addition, although women receive a lower proportion of invasive treatment, they have a higher mortality rate than men. A meta-analysis involving 73 countries and regions (2/3 high-income countries), 446 articles, and 32,875,226 research participants (the median proportion of women is 29%) showed that men often benefit more in the process of the care of acute coronary syndrome, and there are relatively few studies in the pre-hospital and diagnostic stages with significant gender differences. Research in low- and middle-income countries is also insufficient, highlighting the importance of sex differences in the care of acute coronary syndrome.

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