Elsevier

Progress in Cardiovascular Diseases

Volume 46, Issue 4, January–February 2004, Pages 287-295
Progress in Cardiovascular Diseases

Epidemiology of coronary heart disease in women

https://doi.org/10.1016/j.pcad.2003.08.001Get rights and content

Abstract

Cardiovascular disease (CVD) is the leading cause of mortality in women and a major cause of morbidity. Coronary heart disease (CHD) accounts for nearly half of all CVD deaths. Gender differences in CHD include a later age of onset for women, a greater prevalence of comorbid diseases, and differences in the initial manifestations of the disease. Traditional risk factors for CHD include tobacco use, hypertension, diabetes mellitus, dyslipidemia, obesity, sedentary lifestyle, and atherogenic diet. More recently identified risk factors in women include high sensitivity C-reactive protein (hsCRP), homocysteine, and lipoprotein (a). Appropriate management of risk factors is associated with a reduced incidence of CHD, yet poor implementation in women is widely documented. Barriers to optimal risk factor management in women should be identified and overcome in an effort to maximize the cardiovascular health of women.

Section snippets

Myocardial infarction

There is a growing body of evidence to support gender differences in presentation, clinical characteristics, and outcomes of CHD and acute coronary syndromes.6, 7, 8, 9 Regardless of gender, chest pain is the most common presenting symptom of acute MI; however, women are more likely than men to present with atypical findings such as nausea and jaw pain.7, 10 It is important to recognize these differences in presentation, because 50% of MIs are unrecognized in women versus 33% in men.11

As

Risk factors

There are well over 200 known risk factors for CHD, and the number continues to expand.20, 21, 22 The major identified risk factors for CHD in women are tobacco use, hypertension, DM, dyslipidemia, obesity, sedentary lifestyle, and atherogenic diet.3 Although traditional CVD risk factors for women are the same as those identified for men, summarized below are gender-specific differences in prevalence rates and relative risks associated with specific risk factors.

Prevention guidelines

The AHA has issued prevention guidelines for women, which are currently being updated.99 Lifestyle modification should be the initial focus of risk reduction for all women. Hypertension, diabetes, and dyslipidemia should be managed to achieve risk factor goals. For women with established CVD use of beta-blockers, angiotensin-converting enzyme inhibitors, and aspirin should be recommended unless contraindicated in most cases.

Barriers to prevention

Proper management of risk factors is vital to primary and secondary prevention of CVD, and there are substantial data showing that women are not at target levels of prevention. Patient, physician, and societal barriers must be overcome to improve implementation of risk factor modification.100

An initial barrier to prevention of CVD in women may be lack of awareness of risk. A large gap between actual and perceived lifetime risk of CHD has been widely documented.101, 102, 103, 104 An AHA national

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