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Doctor Profile |
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 with obstructive coronary disease have less extensive disease and better left ventricular function, but their outcomes are still similar to their male counterparts'. Women tend to have smaller arteries than men, which leads to lower rates of success with revascularization therapy. When a man receives a woman's heart through cardiac transplant, the smaller female arteries grow larger. Women have a higher prevalence of traditional risk factors at the time of angiography, yet they have a lower incidence of multivessel disease and fewer significant stenoses. "Syndrome X" is used to describe women with chest pain, an abnormal stress test, and normal coronary arteries by angiography. This has been attributed to endothelial dysfunction in women; however, evidence suggests that this may also be related to women's arteries aging differently from men?s arteries. In addition, women have worse outcomes after PCI and coronary artery bypass graft surgery than do men. Most of this difference has been attributed to women?s being older at the time of their procedures and technical factors related to the procedures. Women tend to have smaller arteries, making both percutaneous intervention and coronary artery bypass surgery more challenging. Women have higher rates of mortality after CABG than do men. They also report higher rates of depression and a lower quality of life. Among patients who are undergoing coronary interventions and CABG, women have a higher prevalence of heart failure. However, they are less likely to have LV dysfunction, which has been attributed to diastolic heart failure or hypertensive heart disease. Having heart failure at the time of PCI or CABG increases a patient?s risk of mortality. Women are more likely to develop diastolic dysfunction or congestive heart failure with preserved LV function and are more likely to die after a diagnosis of heart failure. In conclusion, women account for almost half of MI patients, and more women than men die annually from cardiovascular causes. Women may present differently from men and may respond differently to treatment. Clinicians may be slower to suspect ischemic heart disease in women and treat female patients less aggressively. Increased awareness of these issues should lead to a stronger focus on correcting them.