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Management of coronary heart disease in women

Authors
Pamela S Douglas, MD
Neha Pagidipati, MD, MPH
Section Editors
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Patricia A Pellikka, MD, FACC, FAHA, FASE
Deputy Editors
Howard Libman, MD, FACP
Gordon M Saperia, MD, FACC

INTRODUCTION

There are significant differences between women and men in the epidemiology, diagnosis, response to therapy, and prognosis of coronary heart disease (CHD) that should be taken into account in the care of women with known or suspected disease. In addition, women are generally underrepresented in cardiovascular randomized studies and data suggest that women are not referred as often as men for appropriate therapeutic procedures in clinical practice [1,2].

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. Although unadjusted outcomes with therapies such as an early invasive strategy in non-ST elevation acute coronary syndromes, and fibrinolytic therapy or primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction, are often worse in women than men, these differences are almost entirely due to confounding risk factors (eg, older age, more diabetes, more hypertension), not female sex [3-7].

The management of CHD in women will be reviewed here. The clinical features, including diagnosis, the outcome after acute myocardial infarction, and issues in younger individuals 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".)

SECONDARY PREVENTIVE INTERVENTIONS

All women and men with established cardiovascular disease have a high risk of subsequent cardiovascular events, including myocardial infarction, stroke, and death. Therapeutic lifestyle changes such as increased physical activity, dietary modification/weight loss, and smoking cessation are of proven benefit and are likely to improve outcomes beginning within a matter of months. Adjunctive drug therapies of proven benefit include aspirin and statins, and in patients with myocardial infarction or heart failure, include beta blockers and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. In addition, other adjunctive therapies of value, such as influenza vaccination, should be recommended to the patient. (See "Prevention of cardiovascular disease events in those with established disease or at high risk".)

Cardiac rehabilitation — Although cardiac rehabilitation benefits women after an acute coronary syndrome (ACS) event [8], women are less likely to be referred to cardiac rehabilitation. For example, according to a study of Medicare claims, only 14.3 percent of women, compared with 22.1 percent of men, utilize these programs [9]. (See "Cardiac rehabilitation programs" and "Cardiac rehabilitation: Indications, efficacy, and safety in patients with coronary heart disease".)

                 
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Literature review current through: Nov 2017. | This topic last updated: Sep 11, 2017.
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