Coronary Artery Disease: Continuously Neglected in Women

Photo: Male and female

Coronary Artery Disease is still neglec-
ted in women: they are less likely to receive preventive recommendations than men at a similar risk level;
© Kollidas

Despite coronary artery disease (CAD) killing at least as many women as men each year, women are still today less likely to receive preventive recommendations than men at a similar risk level.

Worldwide, 8.6 million women die from cardiovascular diseases (CVD, which includes CAD) each year, accounting for a third of all deaths in women. "CAD is a leading cause of death of women and men worldwide. Yet CAD's impact on women traditionally has been underappreciated due to higher rates at younger ages in men," say the authors of the current study. "Microvascular coronary disease disproportionately affects women. Women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. Trial data indicate that CAD should be managed differently in women."

"More women than men die of CAD, and more women have died from CAD than of cancer (including breast cancer), chronic lower respiratory disease, Alzheimer's disease, and accidents combined," say the authors. There has been some good news, in that from 1998 to 2008, the rate of death from CAD declined 30% in the USA (with similar falls in other developed countries); however, rates are actually increasing in younger women aged 55 years and under due to a variety of risk factors.

Different risk factors appear to affect the sexes differently, with obesity increasing risk of CAD by 64% in women but by only 46% in men. Women who suffer a CAD-related heart attack at a younger age (less than 50 years) are twice as likely to die as men in similar circumstances. Among older individuals (over the age of 65), women are more likely to die within the first year after a heart attack. Overall, 42% of women who have heart attacks die within 1 year, compared to 24% of men. And based on pooled estimates from multiple countries, women are also 20% more likely to suffer angina than men.

The authors say that awareness of the tremendous impact of CAD has on women among women themselves is slowly increasing. In 1997, only 30% of American women surveyed were aware that the leading cause of death in women is CAD; this increased to 54% in 2009. But in a survey performed in 2004, fewer than 1 in 5 physicians recognized that more women than men die each year from CAD. Furthermore, cardiac rehabilitation after heart attacks is underused, particularly in women, as demonstrated in numerous national studies. Women are 55% less likely to participate in cardiac rehabilitation than men are.

The authors conclude: "Women are affected by CAD in large numbers and to a large degree. CAD is the leading cause of mortality in women. The manifestation of CAD has unique characteristics in women. Increasing data demonstrate that some treatment strategies have sex-specific effectiveness. Further research regarding the pathophysiology of CAD in women, diagnosis, and treatment strategies specific to women is required. CAD is not a 'man's only' disease, and we eagerly await future studies that examine its unique presence in women."; Source: World Heart Federation