Cardiovascular disease remains the leading cause of mortality in both women and men in the industrialized nations. Coronary heart disease (CHD) accounts for the single largest share of this toll in both sexes. Although it had long been known that the number 1 cause of death in men is CHD, it was determined only relatively recently that this was also true in women. Identification of the traditional risk factors (RFs) for CHD by the Framingham Heart Study and other investigations during the last 5 decades has provided the basis of preventive cardiology. These RFs can be considered as fixed or modifiable. Numerous epidemiologic and clinical studies have demonstrated that, with few exceptions, the major RFs that increase the hazard for CHD are the same for both men and women, whether fixed (age, sex, family history) or modified (lipids, blood pressure, smoking). A number of other RFs are under investigation and await confirmation in rigorous prospective studies. Even those conditions unique to women, which can predispose patients to CHD, such as polycystic ovaries and complications of pregnancy, act through provocation of the traditional RFs. Thus, the large body of evidence that supports the similarity of RFs for CHD in men and women provides a rational foundation for similar strategies of prevention in the 2 sexes.
IntroductionThe question is whether prevention of coronary heart disease (CHD) in healthy men and women requires different or fundamentally similar strategies. As will be shown in this brief review, the answer is a resounding ''Yes!'' to the latter strategy, based on an abundance of evidence.It has been recognized for over half a century that cardiovascular disease (CVD) is the leading cause of mortality in our society.1 The grim toll of CVD in men has long been noted, but more recently, CVD has received increased attention as the leading cause of death in women.2 By the end of the last decade, CVD deaths in this country totaled over 800 000/yr. 3 Within this scourge, atherosclerotic CHD accounted for the highest toll in both sexes. 3 The number of CHD deaths in women actually exceeded that in men; however, this may be related to the greater number of women in the elderly population, the group in which CHD incidence is highest. 4 The demographic disparity between elderly women and men is reflected by their numbers in the population over age 75 years, which included ∼10.5 million women and ∼6.0 million men in 2000. 4 It is also of interest that only after age 75 years does CHD exceed cancer as the number 1 cause of mortality in women, at which point it becomes the leading cause of mortality over the lifetime.5 These grave statistics for women and men have resulted in major programs to reduce the CHD epidemic by preventive approaches based