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Anna K. Baer, MD
Albemarle Cardiology, PLC
Cardiovascular disease is the leading cause of death for American women.
More than 250,000 women die each year from ischemic heart disease.
Only 13% of women consider heart disease to be their greatest health risk.
38% of women who have an MI die within one year, compared with 25% in men.
Women are more likely to present with atypical symptoms.
Women are less likely to have obstructive coronary disease.
Stress testing may not be as accurate in women.
Women have worse outcomes after PCI and CABG.
Women often report unusual symptoms such as fatigue, lack of energy, sleep problems, and shortness of breath. In a woman, it may be useful to pay closer attention to the onset of symptoms and their relationship to activity. Women may also notice their symptoms more during emotional stress or daily physical activities rather than during exercise. Almost one half of women presenting with a myocardial infarction deny having previous chest pain.
The most common presentation for a woman with obstructive coronary artery disease is sudden cardiac death. In other cases, women commonly present with atypical symptoms including fatigue, shortness of breath, and atypical chest pain. The correlation of symptoms with obstructive coronary disease is not as accurate in women as it is in men.
Risk factors may mean different things in women than in men. For a woman, a weight gain of 42 kg puts her at as high a risk for ischemic heart disease as does smoking. A woman with hypertriglyceridemia may be at greater risk than her male counterpart. Women with diabetes have a significantly greater risk of dying from coronary heart disease than men with diabetes. Women have higher rates of depression, which may put them at greater risk for poor compliance with therapy and developing risk factors. A review of traditional risk factors in a woman may underestimate her risk for cardiovascular disease.
Slightly more women than men die annually of cardiovascular disease. The incidence of myocardial infarctions has decreased in young men while it continues to increase in older women. The relative risk of stroke is much higher in women than it is in men. Despite these figures, in a 2003 AHA poll, only 13% of American women considered heart disease their greatest health risk. Over the last 10 years, there has been a decrease in coronary heart disease mortality among men, but the death rate among women continues to increase. 38% of women who have an MI die within one year, compared with 25% of men. Most of the literature regarding the diagnosis and management of coronary heart disease is supported by studies performed in predominately male populations. Recent studies have focused on the differences between men and women and the differences in treatment between men and women when dealing with cardiovascular disease.
Making the diagnosis of ischemic heart disease in women may be more challenging. Women are more likely to have microvascular disease and less likely to have obstructive coronary disease. Also, assessment of traditional risk factors may not be as revealing in women. Women are more likely than men to have a false positive stress test. Treatment of women with suspected microvascular disease should include aggressive risk factor modification, including the use of statins, ACE inhibitors, and aspirin.
Slightly more women than men die annually of cardiovascular disease. The incidence of myocardial infarctions has decreased in young men while it continues to increase in older women. The relative risk of stroke is much higher in women than it is in men. Despite these figures, in a 2003 AHA poll, only 13% of American women considered heart disease their greatest health risk. Over the last 10 years, there has been a decrease in coronary heart disease mortality among men, but the death rate among women continues to increase. 38% of women who have an MI die within one year, compared with 25% of men. Most of the literature regarding the diagnosis and management of coronary heart disease is supported by studies performed in predominately male populations. Recent studies have focused on the differences between men and women and the differences in treatment between men and women when dealing with cardiovascular disease.
Making the diagnosis of ischemic heart disease in women may be more challenging. Women are more likely to have microvascular disease and less likely to have obstructive coronary disease. Also, assessment of traditional risk factors may not be as revealing in women. Women are more likely than men to have a false positive stress test. Treatment of women with suspected microvascular disease should include aggressive risk factor modification, including the use of statins, ACE inhibitors, and aspirin.