Volume 70 Number 5 October 2003	back to contents

Fellow in Cardiology, The Zena and Michael Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY.

Address all correspondence to W. Lane Duvall, M.D., The Zena and Michael Wiener Cardiovascular Institute, Box 1030, Mount Sinai School of Medicine, One East 100th Street, New York, NY 10029; E-mail: william.duvall@mssm.edu.

Adapted from a Cardiology Grand Rounds, Controversies in Cardiology presentation to the Department of Medicine, Mount Sinai School of Medicine, New York, NY on April 29, 2002 and updated as of November 2002.

ABSTRACT

Almost 62 million Americans have one or more types of cardiovascular disease and, of these, more than 32 million are female. This translates into an average of 1 in 5 women, making cardiovascular disease the leading killer of women in the U.S., responsible for more than half a million deaths a year.

While it has been known for some time that differences exist between the sexes regarding coronary heart disease, it has only been in the last 10 years that these disparities in incidence, morbidity, mortality, risk factors, diagnosis, and treatment have been explored. Research has shown a gap in the utilization of medical therapy, diagnostic studies, and revascularization procedures involving women. In addition, women’s outcomes after myocardial infarction have been consistently demonstrated to be poorer than those of men. Another important issue that has just started to be addressed is that the predominantly male-focused cardiovascular research has been generalized to women. Only in recent years have women been included in clinical trials or databases in sufficient numbers for sex-based analysis of the data.

The topic of cardiovascular disease in women is diverse and complex. In this article, some of the important issues will be introduced and discussed, highlight our current understanding of the problem and to emphasize the areas in which further study and progress is needed. These issues include the epidemiology of coronary heart disease, the diagnosis of coronary heart disease, the medical therapy of acute coronary syndromes, coronary revascularization, and hormone replacement therapy.

KEY WORDS

Coronary heart disease, women, coronary artery disease, epidemiology, prevention, risk factors, hormone replacement therapy.

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