Preventing, detecting, and treating coronary artery disease

A woman who has heart disease is 50% more likely to die from it than a man who has it.

Although experts can point to a number of possible explanations for this, the research on women and heart disease remains inadequate, says the new edition of a Harvard Medical School report, The Healthy Heart: Preventing, detecting, and treating coronary artery disease.

Even though men are more likely to develop cardiovascular disease than women, about 38% of women who have a heart attack die within a year of the event, compared with 25% of men. And women are almost twice as likely as men to have a second heart attack within six years of the first.

The science behind the differences is unclear. These are some of the theories discussed in The Healthy Heart:

• Age. Women seem to become more vulnerable to heart disease only after their estrogen levels fall with menopause, and so they tend to suffer first heart attacks later than men. Advanced age may make it more difficult to survive a heart attack.
• Coronary microvascular disease. This new diagnosis may apply to 50% to 60% of women, compared with 20% of men. These people have chest pain when they are active or stressed, but on angiograms, their coronary arteries appear clear. Studies show that women with coronary microvascular disease have a higher risk for heart attack or stroke.
• Inferior diagnosis and treatment. Some studies suggest women's heart problems don't receive the same attention as men's.
• Incomplete understanding of symptoms. Classic heart attack symptoms were defined based on studies on men. These symptoms don't always occur in women, which may delay diagnosis and treatment.

Also in this report:

• Reducing risk factors for heart disease
• Your personal risks and goals
• Diagnosing heart disease
• Handling a heart attack
• Heart-healthy lifestyle
• Medications and surgery

The Healthy Heart: Preventing, detecting, and treating coronary artery disease is available for $16 from Harvard Health Publications, the publishing division of Harvard Medical School. Order it online at www.health.harvard.edu/E or by calling 1-877–649–9457 (toll free).