Acute coronary syndromes: the gender gap in the new ESC guidelines still remains unfilled

The new guidelines of the European Society of Cardiology on acute coronary syndromes (ACS) were published during the first day of the European Congress 2023. Great expectations have been placed on the ability to include in these guidelines all the evidence that has emerged in recent years, demonstrating that ACS has different risk factors, clinical and electrocardiographic presentations, responses to therapy, and rehabilitation outcomes between men and women. In particular, women historically and frequently suffer from a poor recognition of clinical symptoms, often mistakenly labeled as ‘atypical’, but better defined as ‘peculiar’. As a result, women are undertreated and not referred to cardiac rehabilitation. While the new guidelines have presented an extremely important approach to inclusiveness, we believe that the gender gap in diagnosis and treatment can only be addressed through an effective shift in the clinical and scientific paradigm. This involves adequately educating healthcare personnel about the existence of the various forms of ACS, raising awareness among women that ACS is the leading cause of death after menopause, and creating a comprehensive supportive welfare system to ensure equal access to healthcare for all, spanning from the prevention of individual risk factors to secondary prevention and rehabilitation.