Coronary Heart Disease in Women: Differences of risk factors, clinical manifestations, value of some diagnostic procedures and treatment approaches

In pre-menopausal women, the incidence of coronary heart disease (CHD) is lower than in men. Although it looks as an advantage for women, unfortunately, most of the time they are not evaluated carefully enough for their complaints which may be related to CHD. We know that, risk factors for CHD, clinical manifestations, value of some diagnostic procedures and treatment approaches have some differences between women and men. For example, diabetes mellitus is a more important risk factor for development of CHD in women. Specificity of dobutamine stress echocardiography in CHD and the incidence of false positive result to treadmill exercise test is greater in women than in men. An entirely normal maximal exercise stress study, however, retains a good negative predictive value for excluding serious CHD in women. The women with the complaint of angina pectoris undergo cardiac catheterization with lower ratio, and the prevalence of significant lesions in coronary arteries is lower in women with typical angina than in men. Female patients with acute myocardial infarction (MI) have usually more risk factors for CHD and the incidence of developing congestive heart failure is higher. The incidence of mortality due to CHD, complications of coronary artery bypass surgery and its early mortality rate are also greater in women. Women are less likely to receive thrombolytic therapy in the acute phase of MI, even if eligible, and are likely to experience greater delay in being treated. Female patients receiving thrombolysis have a higher rate of mortality and morbidity compared to men.