Gender differences : Coronary Artery disease

  • Gender differences
    • Coronary Artery disease
      • Men
        • First heart event for men is more often Ml than angina.
        • Men report more typical signs and symptoms of angina and MI.
        • Men receive more evidence-based therapies (e.g., aspirin, statins, diagnostic catheterization, PCI) when acutely ill from CAD (e.g., MI) than women.
        • Mortality rates from CAD have decreased more rapidly for men than women.
      • Women
        • Women experience the onset of heart disease approximately 10 years later than men.
        • CAD is the leading cause of death for women, regardless of race or ethnicity.
        • More women with MI (compared to men with MI) die of sudden cardiac death before reaching the hospital.
        • Before menopause, women have higher HDL cholesterol levels and lower
        • LDL cholesterol levels than men. After menopause LDL levels increase.
    • Acute coronary syndrome
      • Men
        • After age 75, the incidence of MI in men and women equalizes.
        • Men present more frequently than women with an acute MI as the first manifestation of CAD.
        • Men develop greater collateral circulation than women.
        • Men have larger-diameter coronary arteries than women.
        • Vessel diameter is inversely related to risk of restenosis after interventions.
        • Standard screening for risk of sudden cardiac death (e.g., EP studies) is more predictive in men.
      • Women
        • Women are older than men when seen with first MI and often have more co-morbidities.
        • Women seek medical care later in the CAD process and often are more ill on presentation than men.
        • First heart event for women is more often unstable angina than MI.
        • Once a woman reaches menopause, her risk for an MI quadruples.
        • Fewer women than men manifest the “classic” signs and symptoms of UA or MI.
        • Fatigue is often the first symptom of ACS in women.
        • Women experience more “silent” MIs compared with men.
        • Among those who have an MI, women are more likely to suffer a fatal heart event within 1 year than men.
        • Women report more disability after a heart event than men.
        • Women who have coronary artery bypass graft surgery have a higher mortality rate and more complications after surgery than men.