It is important to highlight why we should focus on women’s cardiovascular health in particular. In contrast to historical thought, cardiovascular disease (CVD) is not just a “man’s disease” as CVD is the no. 1 killer in women . One third of all deaths in women are due to CVD, one woman dies of heart disease every minute, and CVD kills more women than men every year (since 1984). Contrary to popular belief, heart disease deaths are 11 times higher than breast cancer deaths. More women die of heart disease each year than all types of cancer plus all other diseases combined . An emphasis must be placed on prevention of CVD as once women are diagnosed with a myocardial infarction (MI), their outcomes are worse than those of men. Women are more likely to die within a year of MI than their male counterparts. Of women who survive an MI, nearly half will be disabled by heart failure within 6 years. The cause for this disparity in outcome is likely multifactorial; however, older age at onset of CVD and lack of awareness may contribute to poorer outcomes than those of men .
Overall, heart disease mortality rates have substantially declined in the US. From 1999 to 2005, US cardiac deaths decreased by 25%, translating into 160,000 fewer deaths in 2005 ( Fig. 1 ) Several factors contributed to this progress, including improved treatment of established CVD, widespread statin use, aggressive antihypertensive management, antismoking legislation, and tobacco excise taxes. Unfortunately, despite this significant progress in the overall population, women as well as other subgroups, such as African Americans, people living in the southern United States, and those with lower socioeconomic status, lag behind .
One reason why these gender disparities exist may begin with the diagnosis and treatment of coronary artery disease (CAD) in women. Women undergo fewer diagnostic procedures for CAD than men. Once diagnosed, women are more often managed medically and undergo less coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) than men ( Fig. 2 ). These gender differences were studied in a stable angina population in the EuroHeart Survey. In this population of 3779 patients (42% women), women were less likely to undergo an exercise ECG or be referred for coronary angiography. Women with confirmed disease were less likely to receive antiplatelet and statin therapies, although beta blocker use was similar. When looking at outcomes, these women had a higher probability of death or MI at 18-month follow-up as well ( Fig. 3 ). This data highlights the fact that women are more likely to receive medical vs. invasive therapies, although this medical treatment is not optimal.
