CVD IN WOMEN: A FRESH PERSPECTIVE
Ezra A. Amsterdam, M.D., University of California, Davis, CA, U.S.A.
Recognition that cardiovascular disease is the leading cause of mortality in women has stimulated major interest and improvement in the detection, prevention, and treatment of CVD in women. Certain aspects of this subject require further clarification and will be considered in this presentation: 1) CVD is the chief cause of death in women after the age of 75 yr, and prior to this age it is preceded in this statistic by cancer. 2) Because the toll of CVD is so high after 75 y.o., averaged over the lifetime, CVD is the leading cause of mortality in women. 3) MI, and especially fatal MI, is rare in premenopausal, nondiabetic, nonsmoking women. 4) CVD frequency rises sharply ~10 yr post-menopause but always lags behind that of men. 5) Primary prevention of CVD in women, as in men, is based on the traditional risk factors and despite its limitations, the Framingham risk score is a useful initial approach to risk estimation and can be refined by addition of family history and metabolic syndrome. 6) Women (and the elderly) have an increased frequency of atypical symptoms of ACS but the majority of this population presents with typical symptoms. 7) The first diagnostic method for CAD in women who can exercise and have a normal baseline ECG should be the exercise treadmill test, as recommended by ACC/AHA guidelines. 8) Current guidelines recommend similar treatment of women and men for most aspects of ACS and favor initial conservative therapy for women with a low risk presentation. 9) Recent data demonstrate an identical frequency of coronary microvascular dysfunction in the two sexes with chest pain and nonobstructive CAD. 10) The markedly increased frequency of Takatsubo cardiomyopathy in postmenopausal women than other segments of the population has not yet been clarified.