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Management of coronary heart disease in women

Pamela S Douglas, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
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 (figure 1), CHD still accounted for 35 percent of all-cause mortality in women in 1995 [2]. 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.

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 (figure 2A-B). Unfortunately, data from clinical trials about the management of women with an acute coronary syndrome (myocardial infarction or unstable angina) are limited, since women are generally underrepresented in randomized controlled studies [3]. Furthermore, most available data suggest that women are not referred as often as men for appropriate diagnostic and/or therapeutic procedures. (See 'Coronary reperfusion' below.)

A repeating theme that will be described below is that unadjusted outcomes are often worse in women than men. However, with issues such as an early invasive strategy in non-ST elevation syndromes, fibrinolytic therapy or primary percutaneous coronary intervention in ST elevation myocardial infarction, and percutaneous coronary intervention in general, these differences are almost entirely due to confounding risk factors (eg, older age, more diabetes, more hypertension), not female sex [4-8].

The management of CHD in women will be reviewed here. The clinical features, including diagnosis of CHD in women, the outcome after acute myocardial infarction (AMI), and the problem of CHD in young women are discussed separately. (See "Clinical features and diagnosis of coronary heart disease in women" and "Coronary heart disease and myocardial infarction in young men and women".)

The success rate of therapy for CHD is similar in women and men; however, the complication rates differ, resulting in a sex specific profile of benefit (see below).


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Literature review current through: Jul 2017. | This topic last updated: Apr 28, 2015.
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