Cardiovascular disease in women

Abstract

Cardiovascular disease (CVD) is the leading cause of death among women, causing more annual deaths than cancer, accidents, Alzheimer's disease, and respiratory diseases combined. Recent data suggest that CVD causes approximately one death per minute among women living in the United States. Somewhat surprisingly, although cardiovascular disease claims more women's lives each year than it does for men, women actually have lower rates of both obstructive coronary disease and depressed left ventricular function. Though great strides have been made in reducing the overall burden of cardiovascular disease, the improvement among women has lagged behind that of men, and the prevalence of cardiovascular disease in young women is actually on the rise. A number of differences exist in the effects of risk factors for and the presentation of cardiovascular disease in women. Overall, women are more likely to present without chest pain than men, and mortality in the setting of myocardial infarction is higher among women than similarly aged men, a difference that is particularly pronounced among young women. Despite a lesser burden of obstructive coronary disease, however, women have worse outcomes than men. Women face higher myocardial infarction-related mortality and are more frequently hospitalized for heart failure exacerbations. This disconnect between the burden of obstructive coronary disease and outcomes has led to the recognition that the pathophysiology of coronary disease among women is quite heterogeneous with microvascular dysfunction, a more common explanation than previously recognized. Additional cardiovascular conditions unique to or more common in women include stress cardiomyopathy and cardiovascular disease associated with rheumatologic conditions.