You’ve Come a Long Way, Baby

eart disease is the leading cause of death for women both in the United States and in most of the industrialized world.Whereas cardiovascular deaths in US men have declined, the number of cardiovascular deaths in women remains unchanged or is increasing. 1 The onset of clinical manifestations of coronary heart disease (CHD) in women lags behind men by about 10 years and by as much as 20 years for more ominous events such as myocardial infarction and sudden cardiac death.Despite this age disparity in coronary events for women, with the aging of the US population and with elderly US women outnumbering elderly men, each year since 1984, more US women than men have died of cardiovascular disease.The sex gap in mortality continues to widen.But CHD is not solely a problem for elderly women.More than 9000 US women younger than 45 years sustain a myocardial infarction each year.The question of why women younger than 65 years of age are more than twice as likely to die from an acute myocardial infarction than comparably aged men is intriguing.Among survivors, 25% of men versus 38% of women die within a year after an initial myocardial infarction.Within 6 years after myocardial infarction, 18% of men but 35% of women will have a recurrent infarction.Women with unstable angina have a survival advantage compared with men, in contrast to their more lethal outcomes after myocardial infarction.Can the more favorable prognosis with unstable angina be exploited by interventions designed to avert myocardial infarction?CHD accounts for almost 250 000 female deaths annually.Almost every minute, a US woman dies of cardiovascular disease. 2 Recent reports from the National Heart, Lung, and Blood Institute (NHLBI) Dynamic PTCA Registry indicate that, despite their persistent high-risk characteristics, women who undergo percutaneous coronary interventions have improved procedural success rates and outcomes.Nonetheless, women continue to have more anginal symptoms than do men after percutaneous coronary intervention, with resultant limitations on their activities and quality of life.Women have a mortality rate from coronary artery bypass graft (CABG) surgery that is almost double that of their male peers, with women younger than age 50 years 3 times more likely to die at CABG surgery than comparably aged men.Recent sex-based analyses of CABG surgery suggest that diabetes and urgent or emergency presentations accounted for the predominance of this doubled fatality risk. 2 An excess of bleeding complications, with their pathogenesis as yet unexplained, is reported for women who undergo all interventional procedures (eg, coronary thrombolysis, percutaneous coronary interventions, CABG surgery), likely contributing to the adverse outcomes for women.