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Women and Heart Disease

Gender Differences

While the incidence of CAD is lower among women than men, its effects in women are just as devastating as in men. However, diagnosis and prognosis in women can be very different, and many challenges exist in risk stratification and decision making for this population, demonstrating the need for a more precise definition of CAD risk in women.7,8

Anatomic, physiologic, and pathologic factors that affect CAD can vary greatly between the sexes. These gender differences can impact the diagnosis and management of CAD in women.

Exercise Electrocardiography (ECG). Exercise ECG has been shown to have a lower sensitivity and specificity in women than in men.7,9,10 Smaller coronary vessels and hormonal status are among the possible factors responsible for the highly variable accuracy of ECG in women.7,9

Menopausal Status. Postmenopausal estrogen loss may contribute to a higher risk for CAD.11 After menopause, CHD rates increase 2- to 3-fold over premenopausal rates.12 A change in lipids after menopause (ie, increased LDL and decreased HDL) may contribute to this increased risk.13

Other Key Gender Differences. Below are some other important differences of which all healthcare professionals should be aware.

  • Women generally present with CHD approximately 10 years later in life than men.14,15
  • Women often delay seeking care for heart disease symptoms,5 which can delay diagnosis and appropriate treatment.
  • Women generally have a greater severity of MI at presentation.5
  • Women are more likely than men to die within a few weeks of an initial MI.1
  • Women experience greater delays to intervention and are less frequently referred for diagnostic catheterization than men.16
  • After MI, women have an excess of posthospital deaths as well as more frequent angina and heart failure among survivors.5
  • Although more women than men die from CVD, only 33% of percutaneous coronary interventions (PCIs) are performed in women, despite the established benefit of such procedures for reducing fatal and nonfatal ischemic complications.16
  • Women consistently tend to have worse PCI outcomes than men.5,16
  • While diabetes increases CHD risk for both men and women,17 it is a much more powerful coronary risk factor for women.5

Facts About CAD in Women

Gender Differences

Symptoms

Chest Pain and Myocardial Infarction

 

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