Coronary Heart Disease in Women: Epidemiology, Clinical Syndromes, and Management

Coronary heart disease accounts for 250,000 deaths per year in American women. The presentation of this disease differs between men and women. The initial manifestations of coronary disease occur later in women. Pathologic and angiographic surveys suggest a tendency in men to earlier, more extensive, and more severe disease. While risk factors for coronary disease are probably independent of gender, three risk factors are particularly onerous in women: lack of ovarian estrogen, cigarette smoking, and diabetes mellitus. The initial presentation of coronary heart disease is more likely to be fatal in women. Further, women are more prone to suffer unrecognized, or "silent." coronary events. They are also more likely to develop Syndrome X. defined as angina with normal coronary angiograms. Noninvasive testing for coronary disease (exercise testing or alternative functional studies) appears to be less reliable in women than in men. Evidence suggests that women are offered the same antiischemic therapies as men once a diagnosis has been established. A growing body of data examines the relative efficacy and safety of certain therapies: blood pressure and lipid reduction as well as revascularization. While still debated, mounting evidence supports the use of estrogen replacement therapy in postmenopausal women for the prevention of coronary heart disease.