Coronary heart disease (CHD) is the
leading cause of death and morbidity among women in the world,
accounting for 1/3 of all deaths in women worldwide. In America,
cardiovascular disease ranks first among all disease categories in
hospital discharges for women. It is estimated that one in two women
will eventually die of heart disease or stroke, compared with 1 in 25
women who will eventually die of breast cancer. Coronary heart disease (CHD)
occurs in women 10 years older than men and are more likely to have
related illnesses such as diabetes mellitus, high blood pressure and
heart failure than their male counterparts.
Diagnosis of Coronary heart disease (CHD)
in women
The diagnosis of
Coronary heart disease (CHD) in women is problematic. In women, the
lower prevalence of Coronary heart disease (CHD), the greater frequency
of atypical chest pain. There is also misconception that female patients
have a benign form of Coronary heart disease (CHD). Less specific
non-invasive tests also make it difficult to diagnose chest pain in
woman.
Previous studies suggest
that chest pain in females were less significant. A Framingham study
indicated that women develop chest pain more often than men, but these
chest pains rarely progress to a heart attack. Half of all women
undergoing coronary angiography in one study did not have significant
heart artery blockage. However, women with classical angina symptom had
a 71% probability of having diseased coronary arteries.
Nearly 90% of women with heart attack had
chest pain as the initial clinical presentation, similar to that of men,
but other symptoms such as breathlessness, fatigue, nausea or upper
abdominal pain are more commonly seen in females than their male
counterparts. Similarly women with stable heart illnesses are more prone
to complain of pain at rest, during sleep or at times of mental stress.
In addition women commonly have chest pain due to illnesses other than
Coronary heart disease (CHD), thus complicating the clinical
presentation and the diagnosis.
Resting ECG commonly shown non-specific ST-T abnormalities in women,
irrespective of whether there is underlying Coronary heart disease (CHD).
Using a treadmill stress test also has a lower sensitivity and
specifically in women compared with men. Other non-invasive tests
(myocardial perfusion stress imaging and stress echocardiography) may
improve the sensitivity and specificity over the conventional treadmill
stress tests in the female population.
Therapy of Coronary heart disease (CHD) in
Women
Pharmacological therapy
using beta-blockers, ACE inhibitors, aspirin, nitrates and cholesterol
loweing drugs have all been shown to be effective in both men and women.
Recent trials have challenged previous belief that hormone replacement
therapy is beneficial to post-menopausal women. Using contraceptive
pills may not increase the risk of heart attack, but if combined with
smoking, the risk is exaggerated several times.
Several reports have documented that women
with Coronary heart disease (CHD) had a worse outcome than that for men.
Women, when compared with men had a higher proportion of sudden death,
higher-in hospital death rate and a more adverse prognosis after heart
attack. This could be explained by the increased age (usually 10 years
older), increased co-mobility such as high blood pressure, diabetes and
heart failure at time of presentation of the illness. Differences in
sizes of the coronary arteries, a greater likelihood of urgent surgical
or interventional procedures may explain part of the poorer outcome in
women. In addition, the less aggressive approach by doctors and less
likelihood of referral for cardiac rehabilitation after a cardiac event
in the past may have contributed to the unequal outcome.
Complication during PTCA is higher for
female patients. More recent data revealed that the gender gap is
narrowing. A slightly better operative mortality was also associated
with surgical treatment for men. After the bypass surgery, women have a
lower likelihood of being free of angina than do men. Females also
experience greater disability and are less likely to return to work than
the males. The rate of long-term survival and re-operation, however, are
similar. Women were counseled
less often than men about exercise, nutrition, and weight reduction.
Women were also found to be less likely than men to be included in the
cardiac rehabilitation programmed after heart attack or bypass surgery.
Efforts are now being instituted to narrow this discrepancy.
Coronary heart disease (CHD) is a major
cause of death and disability in women far exceeds that caused by breast
cancer. The major Coronary heart disease (CHD) risk factors are
generally similar in men and women except with certain emphasis and
minor differences. Diagnosis of Coronary heart disease (CHD) has always
being a challenging task for doctors in view of the atypical symptoms,
perceive benign nature of the condition, less sensitive and specific
nature of some of the non-invasive tests, and the frequent occurrence of
non-coronary chest pain illnesses in women. Many therapeutic medications
can produce satisfactory improvement in both males and females.
Revascularization procedures such as PTCA or bypass surgery are less
successful in women. The apparent less aggressive approach in women with
Coronary heart disease (CHD) has been recognized.
