CAD underrecognized in women

CAD remains a leading cause of death among both sexes, but women are still less likely than men to receive preventive recommendations, according to a state-of-the-art review published in Global Heart.

In the review, Kavita Sharma, MD, and Martha Gulati, MD, MS, FACC, FAHA, both of The Ohio State University, said CAD affects women differently than men.

As shown on CT scans and other imaging techniques, women have narrower coronary arteries than men and are more likely to develop CAD due to microvascular disease, according to a press release. Although they do not appear to have major coronary artery obstructions, they experience symptoms related to blockages of these smaller vessels. Further, more than one-half of women without obstructive CAD have symptoms of ischemia and undergo repeat hospitalization and coronary angiography. Men, however, are more likely to have obstructive CAD.

Martha Gulati

Recent research also indicates that different risk factors affect both sexes differently, according to the release. Obesity, for example, increases the risk for CAD by 64% in women vs. 46% in men, and diabetes increases the risk three- to sevenfold vs. two- to threefold in men.

Autoimmune diseases, which are more likely in women than men, also raise risk for CAD, the release states. Polycystic ovary syndrome, preeclampsia and gestational diabetes are conditions unique to women that can increase risk for CAD.

Breast cancer also increases this risk, according to the researchers.

“Whether the increased CAD risk is due to breast cancer therapies or to the disease itself, which is associated with some of the same risk factors for CAD, remains unknown,” they wrote in the review.

Risk for death is twice as high among women who experience a CAD-related MI at a younger age as compared with men. Similarly, older women are more likely to die within the first year after an MI, and 42% of women who have MIs die within 1 year vs. 24% of men. Women are also 20% more likely to experience angina than men.

Research shows that women are also 55% less likely to participate in cardiac rehabilitation than men after an MI.

Awareness of the impact of CAD appears to be increasing in women, but a survey conducted in 2004 showed that less than one in five physicians recognized that more women die of CAD each year than men.

“Increasing data demonstrate that some treatment strategies have sex-specific effectiveness. Further research regarding the pathophysiology of CAD in women, diagnosis, and treatment strategies specific to women is required. CAD is not a ‘man’s only’ disease, and we eagerly await future studies that examine its unique presence in women,” the researchers wrote.

For more information:

Sharma K. Glob Heart. 2013;8:105-112.

Disclosure:Cardiology Today was unable to confirm the researchers’ disclosure information.