The High Risk of CHD for Women: Understanding Why Prevention Is Crucial

Coronary heart disease (CHD) is the leading cause of death and disability among adult women in the US. A postmenopausal woman has a 31% lifetime mortality risk from CHD, in contrast to a 2.8% mortality risk from hip fracture and a comparable risk for breast cancer. As many as 1 in 8 women aged 45 to 54 years has clinical evidence of CHD, with the prevalence increasing to 1 in 3 women older than 65 years of age. Once women develop clinical evidence of CHD, their outcomes are less favorable than those for their male counterparts. Data from the Myocardial Infarction Triage and Intervention Registry reveal a hospital mortality rate for acute myocardial infarction of 16% for women, in contrast to 11% for men; 1-year mortality also was greater in women. Among the risk factors that heighten the risk of CHD in women are diabetes, which negates the gender-protective effect, even for premenopausal women; cigarette smoking, which is on the rise in young women; hypertension, which is more prevalent in women than men after 65 years of age; LDL cholesterol levels that begin to rise in women after menopause and exceed levels in men at elderly age; and triglyceride levels that are higher in men than in women at all ages. Oral contraceptives, now prescribed at lower dose, are no longer considered a serious CHD risk factor since they have fewer adverse effects on glucose tolerance, insulin resistance, and lipoprotein levels. Because of the high prevalence of traditional coronary risk factors among US women, preventive strategies are likely to effect substantial benefit. Risk attributes unique to women are topics of active research.