Coronary Artery Disease Prevention, Diagnosis, Prognosis and Treatment: What's Different for Women?
Keywords:coronary artery disease, CAD prevention, CAD in women
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality. Coronary heart disease (CHD) occurs in women a decade later compared with men and the gap between men and women narrows with advancing age. In addition, cardiovascular mortality declines in men but not in women. Coronary heart disease (CHD) accounts for the majority of CVD deaths in women.The spectrum of CVD risk in women (10-year absolute CHD risk) varies from high ( > 20%) for women with established CHD, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, diabetes and chronic kidney disease to intermediate risk (10-20%) for women with multiple risk factors, markedly elevated levels of a single risk factor, metabolic syndrome, first degree relatives with early onset of CVD and subclinical CVD (e.g. coronary calcification) and low risk (< 10%), mainly for women with 1 or no risk factors. Hypertriglygeridemia, low HDL cholesterol, diabetes and the metabolic syndrome are more potent risk factors for CHD in women compared with men. High-sensitivity C-reactive protein (CRP) and anemia are other novel risk factors for women and hypoestrogenemia of hypothalamic origin may be a risk factor for pre-menopausal women and one possible cause for the increased mortality in young women versus age-matched men in acute myocardial infarction (MI) as well as post bypass surgery. For prevention aspirin, ??-blockers, angiotensin converting enzyme (ACE) inhibitors and statins are indicated for higher risk women, whereas for lower risk healthy life style changes are recommended.
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