[Women and cardiovascular diseases, particularly coronaropathies]

Cardiovascular diseases represent the major cause of death in women. If women are early in life relatively protected by their hormones, after the menopause heart disease and stroke become their greatest health threat. Altogether one in three women will die of cardiovascular disease whereas only one in twenty-two will die of breast cancer. The risk factors for cardiovascular diseases are similar in both sexes. It should be noted however that the impact of diabetes on the development of coronary artery disease is markedly higher in woman than in man. In woman the first presenting symptom of coronary artery disease frequently is angina pectoris. In man it is more often an acute myocardial infarction whether it be symptomatic or silent. The various non invasive techniques used for the diagnosis of coronary artery disease may yield results that pose very difficult problems of differential diagnosis in women. Several studies indicate that in the past, probably because of the ignorance by the public and, perhaps, the medical profession of the high prevalence of cardiovascular and coronary artery diseases in women, the latter have not always received an optimal treatment when they suffered an acute ischemic attack. But, in this decade, they have been dramatic changes in the patents of clinical practice related to coronary heart disease in women. Statistical investigations however indicate that thrombolytic therapy appears less efficacious in women than in men whereas beta-blockers administered early in acute MI are of remarkable efficacy in women. It seems generally agreed that the results of revascularization by coronary artery bypass surgery are poorer in women than in men both in terms of operative mortality and morbidity. Initially, the same pessimism was reported for PTCA. However, recent results allow a much more optimistic view.