Coronary Heart Disease in Women & Men: Similar and Different
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INVITED COMMENTARY
Coronary Heart Disease in Women & Men: Similar and Different Jennifer G Robinson
Published online: 26 October 2013 # Springer Science+Business Media New York 2013
Abstract Coronary heart disease remains the leading cause of death in women. Although improving, preventive efforts lag behind that of men. An understanding of CHD presentation, treatment and prognosis may reduce the burden of CHD in women. Keywords Women . Coronary heart disease . Pathophysiology . Prevention . Diagnosis Comment in reference to: Sharma K, Gulati M. Coronary Artery Disease in Women: A 2013 Update. Global Heart. 2013;8(2):105–112. Coronary heart disease (CHD) remains the leading cause of death in women, well ahead of breast cancer, a distant 7th [1]. Understanding the differences in CHD pathophysiology, presentation, treatment and prognosis may help clinicians reduce the burden of CHD in women. The review paper by Sharma and Gulati nicely describes the similarities and differences in CHD between women and men [2]. Key findings are highlighted in the Table 1. Women are older at the time of clinical CHD presentation, and more likely to have non-obstructive CHD due to microvascular disease and endothelial dysfunction. The major risk factors for CHD are the same in women as in men – age, smoking, diabetes, low HDLC level, elevated LDL-C, and blood pressure [3]. Diabetes appears to increase CHD risk more in women than in men. Pregnancy-related complications such as preeclampsia, gestational diabetes, or pregnancy-induce hy-
J. G. Robinson (*) Departments of Epidemiology & Medicine, Prevention Intervention Center, College of Public Health, University of Iowa, 105 River St S455 CPBH, Iowa, IA 52242, USA e-mail: [email protected]
pertension are unique risk factors to women, as are premature ovarian failure and polycystic ovary disease. Because women more often have inflammatory conditions such as rheumatoid arthritis and systemic lupus, the presence of these diseases appears to play a larger role in increasing CHD risk in women [4]. Risk factor treatment has been shown to reduce CHD risk in women as well as in men. In women, antihypertensive therapy has been shown to reduce CHD and stroke events [4]. Statin therapy reduces cardiovascular risk in women as well as in men with clinical CHD [5]. Statins also reduce cardiovascular risk in primary prevention women at sufficiently high risk to benefit [6, 7]. Statins reduce the relative risk of total cardiovascular events similarly in women as in men, although women experience more stroke risk reduction and men experience more CHD risk reduction. Aspirin should be reserved for women with CHD or who are at sufficiently high risk to benefit (which typically does not occur until after age 65) [4]. Postmenopausal hormone therapy has not been shown to be beneficial, and indeed appears to have net harmful effects. Unfortunately, rates of risk factor treatment and control are lower in women than in men. Exercise stress testing for suspected CHD is considered less accurate in wo
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