For many decades, it has been “conventional” wisdom that cardiovascular disease, namely coronary disease was less frequent and less severe in women than in men. That is simply not the case. As more research knowledge has been accumulated over the years, it’s become clear that although there are some significant differences between men and women, heart disease is every bit as frequent, as severe, and sometimes even more deadly in women than in men. Far more women die of cardiovascular diseases every year, than lung, breast, and ovarian cancer combined.

 What are some of the key differences in women that increase the risk of coronary disease? First, women seem to develop an increased risk of coronary disease about 10 years later than men, that is, at about age 50-55. Cigarette smoking is a very powerful risk factor in women. It increases the risk of heart attacks as well as strokes by 6-9 fold over nonsmokers. Diabetes and obesity also seem to exert a more powerful effect to increase cardiovascular risk in women compared to men. Finally,

Although cholesterol levels are an important risk factor in women, as they are in men, there are critical differences. Triglyceride levels are much more important in women, as are several lipid (cholesterol) fractions that are not routinely measured in the standard cholesterol panel typically ordered in the doctor’s office.

The symptoms of coronary disease are often quite different in women as well. While the majority of women with coronary disease have typical symptoms of angina pectoris, a large number have more unusual symptoms. Many have shortness of breath with exertion rather than chest pain. Women are also more likely to have symptoms of angina at rest, during sleep, or with mental stress. As a result, evaluation strategies for women often need to be more aggressive, particularly as coronary disease is often more advanced/severe by the time it is diagnosed in women.

So what to do to reduce the risk of coronary disease in women? Fundamentally it is the same approach as in men, but with aggressive focus in particular on areas like weight and diabetes management, and smoking cessation – particularly in women taking birth control pills. Additionally, while cholesterol management remains important, the focus is on different fractions of the cholesterol profile than in men, as well as on fractions that we have not previously routinely measured. Finally, it’s important that women be proactive and have a high degree of suspicion when they experience any new or unusual chest symptoms, even if not necessarily associated with physical exertion.

Reid Muller, MD, FACC, FACP