Coronary Atherosclerotic Heart Disease: Some Important Differences in Men and Women

Abstract

Important sex-related differences exist in almost every aspect of coronary atherosclerotic heart disease. In general, women lag some 10-20 years behind men in the incidence of angina pectoris, sudden unexpected death, and acute myocardial infarction. The history is of considerable diagnostic value in men in establishing the presence of significant coronary atherosclerotic heart disease. The value of the history in women is somewhat limited except in the subgroup over 70 years of age with definite angina pectoris. The following noninvasive tests are available to aid the clinician in establishing disease likelihood: (1) exercise electrocardiography; (2) rest and exercise myocardial perfusion imaging with thallium, and (3) rest and exercise radionuclide ventriculography. Each has specific diagnostic limitations in women. Coronary artery bypass surgery in women is associated with a slight increase in operative risk, and this may be related to body size. Percutaneous transluminal coronary angioplasty is associated with a higher initial success rate in men than in women. The long-term outlook following successful percutaneous transluminal coronary angioplasty is brighter in women than in men.

Gender Differences in Recovery after Coronary Artery Surgery

“…Also, since body size is inversely related to graft patency rates, it is not surprising that women, who are smaller, have higher reocclusion rates than men (Tobin et al, 1987). Finally, the diagnosis of coronary artery disease is more complex in women than in men because angina is not correlated with the extent of occlusive disease (Glazer & Hurst, 1987); difficulty in diagnosis probably operates to delay treatment. Thus, women are likely to have surgery later in their illness and as older patients are more likely to experience comorbidity.…”