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Clinical features and diagnosis of coronary heart disease in women

Pamela S Douglas, MD
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editor
Gordon M Saperia, MD, FACC


Cardiovascular diseases are the most common cause of death and disability in women in the United States [1,2]. Although there has been a reduction in the death rate from coronary heart disease (CHD) since 1980 [3], CHD accounted for 35 percent of all-cause mortality in women in 1995 [2] and 23 percent in 2004 [4]. Between the ages of 45 to 64, one in nine women develops symptoms of some form of cardiovascular disease. After age 65, the ratio climbs to one in three women, according to the National Center for Health Statistics [5].

There are significant differences between men and women in the epidemiology, diagnosis, treatment, and prognosis of CHD that should be taken into account in the care of women with known or suspected disease. Furthermore, most available data suggest that women are not referred as often as men for appropriate diagnostic and/or therapeutic procedures, despite similar clinical conditions [6-12]. (See 'Diagnostic testing for suspected CHD' below.)

The clinical features and diagnosis of CHD in women will be reviewed here. The epidemiology and prognosis of CHD, management of CHD in women, and the problem of CHD in young women are discussed separately. (See "Epidemiology of coronary heart disease" and "Management of coronary heart disease in women" and "Coronary heart disease and myocardial infarction in young men and women".)


Women with coronary heart disease (CHD) are generally about 10 years older than men at the time of presentation and carry a greater burden of risk factors [13-15]. Women may not identify their initial symptoms as an expression of heart disease and therefore may not seek medical advice promptly and practitioners may not evaluate symptoms that represent myocardial ischemia as early in women [4,16]. (See "Overview of cardiovascular risk factors in women".)

Although women are generally older than men at presentation, women younger than age 45 years also develop CHD [17] and have a worse prognosis than men [18]. The first presentation of CHD may be chest pain, myocardial infarction (MI), heart failure (HF), or sudden cardiac death (SCD). (See "Coronary heart disease and myocardial infarction in young men and women".)


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