[Does female coronary insufficiency lead to any peculiar therapeutic problems?]

The diameter of the coronary arteries is smaller in women than in men and this phenomenon enhances the difficulty of surgical anastomosis. Atheromatous stenosis is more often confined to a single vessel and, in one out of three female anginal patients, the coronary arteries are angiographically normal. The incidence of spasm is the same in both sexes. However, the prognosis of myocardial infarction is worse in women than in men. In women, smoking is by far the commonest atheromatous risk factor and oral contraception is also significant when associated with smoking and hypertension. Drug therapy of coronary artery disease is the same in both sexes although thrombolysis of acute myocardial infarction gives in women less favourable results in terms of mortality. On the other hand, coronary angiography is less commonly undertaken in women than in men. When operated, women are more difficult to revascularise completely than men and operative mortality is higher. Angina regresses less frequently but survival is the same. Early results of coronary angioplasty are usually poorer in women with a higher incidence of complications and a significantly higher immediate mortality: however, at medium-term, the efficacy of angioplasty is the same in both sexes although more women continue to suffer of anginal attacks. Suppression of smoking and prescription of hormone replacement therapy for menopausal women delay the apparition and limits the severity of female coronary artery disease.