Ischemic Heart Disease in Women

A Review for Primary Care Physicians

Anita V. Kusnoor, MD; Angela D. Ferguson, DO; Ruth Falik, MD

Disclosures

South Med J. 2011;104(3):200-204. 

In This Article

Abstract and Introduction

Abstract

Ischemic heart disease (IHD) is the leading cause of death among women in the Western world, and its prevalence is growing. The pathophysiology of heart disease in women differs from that in men. Women with chest pain and abnormal stress tests are less likely than men to have critical stenosis of coronary arteries, a phenomenon attributed to endothelial dysfunction. Hypertension, intimal injury, and cholesterol are among the various factors that contribute to endothelial dysfunction. The presenting symptoms of IHD also differ in women. Women are more likely to describe neck and throat pain and to characterize the pain as intense, sharp, or burning. A history of coronary or other vascular disease, diabetes, or chronic kidney disease places patients at high risk for IHD. Risk factor modification can be tailored based on each patient's risk. Hormone replacement therapy, antioxidants, folic acid, and aspirin in healthy women under 65 years of age have recently been shown to be ineffective in the prevention of IHD.

Introduction

Ischemic heart disease (IHD) is the largest single cause of death among women in the Western world, accounting for one-third of all deaths.[1] In the United States, more women than men die of IHD. The most typical form of IHD is coronary artery disease (CAD).[2] The burgeoning epidemics of obesity, metabolic syndrome, and diabetes mellitus (DM) affect women disproportionately and are reflected in the growing prevalence of CAD in women.[3] Disease onset is typically about 10 years later in women. Prevalence increases rapidly postmenopause, and is comparable to that seen in men by the seventh decade.[4] The rising prevalence of IHD in women has dramatic economic and public health implications. Its cost in the United States was estimated to be over $475 billion in 2009.[5] Even a modest reduction in the incidence of IHD in women would have an enormous effect on both public health and healthcare expenditures.

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