Management of Stable Ischemic Heart Disease in Women

Abstract

Cardiovascular disease (CVD) remains the most common cause of death in women living in developed countries and outnumbers death from all forms of cancer combined [1]. Since 1984, the number of CVD deaths for females has exceeded those for males. With the advances in the diagnosis and treatment of coronary artery disease (CAD), there have been significant decreases in cardiovascular mortality seen in both sexes, with the major decline for women occurring after the year 2000 [2]. However, this reduction in mortality among women has remained less pronounced as compared with men [3]. The reason for this disparity may be gender differences in the pathophysiology of CAD or lower awareness of coronary disease in women leading to decreased implementation of evidence based care [4]. The Yentl syndrome (as described in 1991) pointed out the ubiquitous misrecognition of CVD as an affliction of men, with women seeming to require a higher burden of proof in order to receive appropriate diagnostic tests and therapeutic interventions [5]. There are recognized gender differences including a notable 10 year delay in the onset of ischemic heart disease (IHD) in women compared to men, that have been attributed to the protective effect of estrogen [6].