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    Coronary Artery Disease: A Significant Problem in Women

    Many women are under the impression that breast cancer represents their greatest health risk. But while breast cancer claimed the lives of 43,091 women in 1996, more than 505,000 women died from cardiovascular disease.

    Coronary artery disease (CAD) is the most common heart problem, and occurs when the coronary arteries become blocked. This leads to a reduction in blood flow to the heart muscle and deprives it of vital oxygen. Blockages are commonly caused by plaque build up, which is a hard substance that sometimes forms when fat, cholesterol and other substances combine. Left unchecked and untreated, this situation may eventually lead to a heart attack and death.

    CAD is a significant health problem for women and it was the subject of a presentation by cardiac experts this week at the annual meeting of the American College of Physicians/American Society for Internal Medicine, in Philadelphia. According to Pamela Charney, MD, of the Jacobi Medical Center/Albert Einstein College of Medicine in New York, gender differences play a role in symptoms, risk factors and prevention of CAD.

    Based on data gleaned from the Framingham study and GUSTO IIb, women with CAD tend to experience symptoms that differ from men's. For example, women will more frequently have attacks of angina or chest pain, whereas men are more prone to a myocardial infarction or heart attack. A woman's angina is frequently unstable and she may experience it while resting, instead of during times of exertion. Higher blood pressure and increased heart rate are also more often experienced by women.

    Gender differences also affect the magnitude of CAD risk factors, Charney says. Diabetes, for example, is a stronger risk factor for women. Women with diabetes are between three and seven times more likely to develop CAD, compared to diabetic men who have a two to three fold elevation in risk.

    There is also a difference between the sexes in cholesterol profiles and how they relate to CAD. In women, HDL-cholesterol levels may be a stronger indicator of CAD than in men - low HDL levels indicate a greater risk than high LDL levels. Charney points out that a few studies have suggested triglycerides may be strong predictors of CAD in women, but she cautions that this research remains controversial.

    When it comes to preventing CAD, both men and women need to lower high cholesterol. And clinical trials have shown that aspirin is an effective means of preventing recurring blockages of the arteries in both sexes. But to date, there is no hard evidence that aspirin will prevent CAD from happening in women in the first place. Researchers have to wait another two years for more conclusive results from an ongoing trial known as the Women's Health Study. Forty thousand female health professionals are testing the effects of taking a low dosage of aspirin on a daily basis. Until that data is complete, "the jury is still out," says Charney.



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