Cardiovascular Disease in Women

Abstract

Cardiovascular disease remains the most common cause of death among men and women of all ethnic groups in the United States. The public health impact of cardiovascular disease in women will increase in the future as the population demographics continue to change as a result of aging of the population and the longer life expectancy among women. Risk factors, such as smoking, dyslipidemia, diabetes mellitus, and hypertension, predispose both men and women to coronary heart disease, but the relative importance of at least some of these risk factors appears to be gender dependent. The diagnosis of coronary heart disease in women is more challenging than in men. Microvascular angina, variant angina, silent ischemia, and silent myocardial infarction appear to be more common in women. Angina pectoris in the setting of angiographically confirmed coronary artery disease carries a similar prognosis in women as in men. Myocardial infarction is associated with a worse prognosis in women, at least in part related to women's advanced age and higher comorbidity. Clinical trials of therapeutic interventions in patients with coronary heart disease have predominantly enrolled men, but subgroup analyses in women suggest that therapeutic benefits are similar in both genders. The need for more research into the basic biologic differences between men and women and their impact on subsequent cardiovascular disease is evident. The usefulness of such research ultimately will depend on its application in clinical practice. The prerequisite for such application is the incorporation of women's health issues at all levels of medical education.