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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.
Another problem is that a traditional stress test may not be as diagnostic in a woman. An exercise ECG without imaging is limited to patients who have a normal resting ECG and patients who can exercise. The ECG diagnostic criteria for a positive test has lower diagnostic accuracy in women than in men. ECG changes during exercise have been reported to be of diminished accuracy in women as a result of more frequent resting ST-T wave changes, lower ECG voltage, and hormonal factors. Furthermore, women undergoing stress testing who achieve only low work levels (<5 mets on the Bruce protocol) may go undiagnosed. Women also tend to have higher false positive rates. Both nuclear stress testing and stress echocardiography seem to be highly sensitive in both women and men.
To further complicate matters, women tend to be treated at later stages of their ischemic heart disease and be treated less aggressively. Women may delay seeking healthcare. They also tend to present with atypical symptoms, which may make a quick diagnosis more challenging. However, a delay in diagnosis may
contribute to worse outcomes in women. There are more male admissions every year for myocardial infarctions, but women have a higher one-year death rate and reinfarction rate than do men. After being treated, women have more problems with anxiety and depression than their male counterparts. They also have more problems with refractory chest pain.
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.
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.