Clinical characteristics of coronary heart disease in women: emphasis on gender differences.

Abstract

Time for primary review 57 days. Coronary heart disease (CHD) is the leading cause of mortality for adult women in most industrialized nations [1,2]. Internationally there is substantial variation in the rates of age-standardized CHD incidence and mortality; countries with high rates of CHD among men also have high rates for women [3]. That environmental/lifestyle factors may exert major importance compared with gender is highlighted by the fact that women in countries with high prevalence of CHD have greater CHD rates than men in countries with low CHD prevalence. Changes in age-standardized CHD mortality rates for men and women between 1981 and 1983 and 1991–1993 show prominent declines in Western European countries, the United Kingdom and the US for both genders, in contrast to increases in mortality rates for both women and men in Eastern European countries, highlighting the potential impact of environmental/lifestyle changes [3]. Within this favorable trend, the percentage decline in mortality rates in the US, the UK and Sweden has been far greater for men than women [4,5]. Although rates of CHD mortality increase prominently with age both for women and men, there is a consistent substantially greater CHD mortality for men at all ages, with the difference most marked at younger ages. The greater age-dependency of CHD for women than men has been known since the early reports of the Framingham Heart Study; any initial manifestation of CHD was delayed about 10 years in women compared with their male counterparts, with initial myocardial infarction (MI) occurring as much as 20 years later [6,7]. Convincing explanations for the CHD gender–age disparities remain elusive. There is not an abrupt increase in CHD rates for women at the time of menopause. By contrast coronary risk factor prevalence in women both in the US and … * Tel.: +1-404-616-4420; fax: +1-404-616-3093