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Review
. 2016 Apr 15;118(8):1273-93.
doi: 10.1161/CIRCRESAHA.116.307547.

Cardiovascular Disease in Women: Clinical Perspectives

Mariana Garcia  1 , Sharon L Mulvagh  1 , C Noel Bairey Merz  1 , Julie E Buring  1 , JoAnn E Manson  2
Affiliations
Review

Cardiovascular Disease in Women: Clinical Perspectives

Mariana Garcia et al. Circ Res. .

Abstract

Cardiovascular disease continues to be the leading cause of death among women in the United States, accounting for ≈1 of every 3 female deaths. Sex-specific data focused on cardiovascular disease have been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex differences as they relate to clinical practice in the prevention, diagnosis, and treatment of cardiovascular disease. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including myocardial infarction associated with nonobstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other cardiovascular disease entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease, and abdominal aortic aneurysms, are also briefly reviewed. Finally, recommendations for cardiac rehabilitation are addressed.

Keywords: acute coronary syndromes; cardiovascular disease; primary prevention; risk factors; women.

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Figures

Figure 1
Figure 1. Traditional and Non-traditional ASCVD risk factors in women
Increasing among women and more impactful traditional ASCVD risk factors include: diabetes, hypertension, dyslipidemia, smoking, obesity and physical inactivity. Emerging, nontraditional ASCVD risk factors include: preterm delivery, hypertensive pregnancy disorders, gestational diabetes, breast cancer treatments, autoimmune diseases and depression.
Figure 2
Figure 2
Percentage of US Adults Classified as Obese (BMI >30 kg/m2) in Health Surveys from 1963–2012.–
Figure 3
Figure 3. Menopausal Hormone Therapy Timeline
Experimental studies have consistently demonstrated beneficial physiologic effects of estrogen on the vascular endothelium at the cellular and molecular level. This long-standing observation led to a hypothesis that estrogens were cardioprotective, which was initially supported by retrospective and prospective observational studies, followed by disappointment from HERS, WHI and other RCTs that failed to demonstrate reduced risks of clinical CVD events with MHT. More recent RCTs include KEEPS (null results) and ELITE (which has supported the “timing hypothesis”). MHT is contraindicated for the primary and secondary prevention of CVD.
Figure 4
Figure 4. Effects on major vascular events per 1·0 mmol/L reduction in LDL cholesterol, subdivided by history of vascular disease and sex
Proportional reduction in major vascular events per 1·0 mmol/L reduction in LDL cholesterol was similar for men and women irrespective of the baseline level of ASCVD risk or subtype of ASCVD outcome assessed. The results were slightly more favorable for men than women (p, heterogeneity by sex <0.05). Reused with permission from the Cholesterol Treatment Trialists (CTT) Collaboration
See this image and copyright information in PMC

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