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There is finally increased attention being paid to the issue of heart disease in women.
It used to be thought that heart disease is a man's disease. But heart disease is the leading cause of death in women as well.
Studies of diagnostic techniques and treatments of heart diseas have traditionally focused on male patients (and usually white male patients). The assumption has been that the same principles apply to woman and men since they are biologically similar.
However, men and women are not biologically identical.
Women with heart disease definitely fare more poorly than men.
Women generally develop heart disease at an older age than men do. Thus they often have other medical conditions that worsen their prognosis and complicates their treatment.
Women have, on the average, smaller coronary arteries than men. This makes it technically more difficult to perform angioplasties, stents and bypass operations. (Oddly enough, when a woman's heart is transplanted into a male recipient, the arteries in that transplanted heart grow larger.)
It is more diificult to diagnose coronary disease in women than men.
Women are more likely to present with "atypical" symptoms than men. Men typically present with chest discomfort with physical activity, a presentation that is in accord with our understanding of when the heart's oxygen supply runs low. Women are more likely to present with discomfort unrealted to physical actvities or they may present with others symptoms such as fatigue, weakness or shortness of breath.
Stress tests do not yield perfectly accurate results in men, but their batting average is even worse for women.
Women with angina are more likely than men to have perfectly normal coronary arteries demonstrated when they undergo coronary angiography. This could mean that their symptoms were not from the heart at all. But women with angina and normal coronary arteries have a worse prognosis than other women. The leading theory to explain this is that they have arteriosclerosis in the small microscopic blood vessels of the heart that cannot be seen by angiography. Treatments that seem to help include beta blockers, ACE inhibitors, statins, and imipramine.
Even in women with coronary disease demonstrated by an angiogram, it is less likely to be severe than in male patients and less likely to benefit from stents or bypass operations. There will be an increased reliance on medications and risk factor modification.
Fortunately, the cardiology community is now intensely focused on the issue of heart disease in women. Research studies are no longer focusing on men alone. Practicing physicians are heightening their awareness of heart disease in women. We are optimistic that the prognosis of women with heart disease will improve in the near future.
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