Coronary heart disease: is gender important?

Abstract

Coronary heart disease (CHD) is the leading cause of death in developed countries. Gender has a significant influence on the cause, clinical manifestation and prognosis of CHD. Men develop CHD approximately 10 to 15 years earlier than women. Non-modifiable CHD risk factors such as age and family history have a different effect in men than in women. Modifiable risk factors also show differences between the sexes. Smoking is more prevalent and hypertension less controlled in men. Overweight and obesity appear to be more potent risk factors in men, and the higher prevalence of abdominal obesity in men increases their risk for CHD. According to some studies this could explain gender differences in the incidence of CHD but women’s significant protection against CHD during their reproductive years could be another explanation. Myocardial infarction is usually the first manifestation of CHD in men and the risk of its recurrence is twice as high in men as in women. A robust database provides evidence that routine thorough cardiovascular risk assessment in men over 40 years of age and in postmenopausal females is a prudent procedure. Lifestyle changes and timely and aggressive therapy for lipid disorders, hypertension and diabetes mellitus can improve the prognosis of high-risk patients.