Coronary heart disease in women. Prevalence and diagnostics.Coronary artery disease (CAD) is a major health care challenge, and is the leading cause of death amongst women. This review of the literature compares prevalence, pathophysiology, risk factors, symptomatology, and diagnostic tools of ischemic heart disease in a gender perspective.
CAD is changing from a fatal disease of middle-aged men to more chronic condition of elderly women. The identification of CAD in women is complicated by more diffuse or ‘atypical’ symptoms, a lower initial detection rate of myocardial ischemia by traditional methods, lower rates of interventional procedures, and lastly, potential differences in the pathophysiology of myocardial ischemia. Identification of CAD in women should be by use of multiple risk factor analysis in combination with more aggressive and multiple forms of diagnostic testing. The lower precision of female disease detection is partly due to differences in pre- and post likelihood of disease, but adds to the existing gender bias in diagnosis and referral rates and contributes to the perception that women have less exertional angina than men, despite observations to the contrary.
Little is known about potential gender differences in the composition and vulnerability of atherosclerotic plaques. The risk factors are basically the same for both sexes, but with a possible larger relative impact of diabetes and smoking in women than in men. On-going international campaigns focus on increasing the awareness in women and their doctors of female susceptibility to CAD, and that more research in women is urgently needed for optimal treatment of both sexes.