Heart disease in older women. Gender differences affect diagnosis and treatment

Cardiovascular disease continues to be the leading cause of death in women over age 50 in the United States. Significant differences exist between men and women in the prevalence, incidence, and treatment outcomes of cardiovascular disease, particularly coronary artery disease. The presenting features of coronary artery disease may very between men and women, and the diagnostic evaluations of such symptoms may differ based solely on gender. Outcomes of angioplasty and bypass surgery, although not as extensively studied in women as in men, may be less favorable. The impact of risk factor modification may also differ due to the effects of menopause on cardiovascular events. More studies of cardiovascular outcomes In women are required, particularly now that hormone replacement therapy has been shown to increase cardiovascular event rates in most of the recent trials. Until such studies are available, our focus should therefore remain on treatment of risk factors where such treatment has clearly been shown to impact favorably on cardiovascular morbidity and mortality.