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Overview of cardiovascular risk factors in women

Pamela S Douglas, MD
Athena Poppas, MD
Section Editor
Juan Carlos Kaski, DSc, MD, DM (Hons), FRCP, FESC, FACC, FAHA
Deputy Editor
Brian C Downey, MD, FACC


Cardiovascular disease (CVD) is the leading cause of death in women [1-3]. Though there has been an overall decline in CVD mortality over the past 40 years, the mortality in younger woman has plateaued since around the year 2000 [4]. The incidence of myocardial infarction (MI) in women, although lower than in men, increases dramatically following menopause. The increase is at least in part due to increasing age since men also have a progressive increase in MI with age (figure 1) [5]. The role of menopause itself is not so clear. (See 'Menopause' below.)

Risk factor reduction may have contributed to the overall decline in rates of CHD in women. In a report from the Nurses' Health Study of 85,941 women who were followed for 14 years, incident CHD was 31 percent lower in the two years from 1992 to 1994 than it was in the two years from 1980 to 1982 [6]. During this time period, the number of subjects who smoked decreased by 41 percent although the number who were overweight increased by 38 percent. It was concluded that the reduction in smoking accounted for a 13 percent decline in CHD, and an improvement in diet explained a 16 percent decline, while the increase in weight accounted for an 8 percent increase in CHD.

An overview of the determinants of cardiovascular risk in women will be reviewed here. The management of women with CVD is discussed separately. (See "Management of coronary heart disease in women".)


As a diagnostic category, cardiovascular disease (CVD) includes four major areas:

Coronary heart disease (CHD) clinically manifested by myocardial infarction (MI), angina pectoris, heart failure (HF), and coronary death


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