March 2006

Women with acute coronary syndromes continue to be undertreated with pharmacologic therapy and invasive procedures, despite the fact that they receive the same benefits from therapy as men. Although the older age at diagnosis for women adds complexity to clinical decision making, studies show that an aggressive medical or interventional approach to acute coronary syndromes is often warranted and should be based on patient size, comorbidity, and renal function.

Drs Pfeifer and Steingart (page 11) provide a timely report on recent findings affecting the assessment and treatment of women with acute coronary syndromes.

Cardiovascular drugs affect women differently than they do men because of differences in pharmacokinetics, pharmacodynamics, and physiology. Results of recent studies on the use of cardiovascular agents in women are presented, with an emphasis on the need to include an appropriate proportion of women in future studies, to adapt the dosage to the weight of the patient, and to incorporate hormonal aspects into the analysis.

A patient's response to drugs may be influenced by many factors, including age, race, sex, ethnic background, metabolic phenotype, body fat content and distribution, and body size. Drug–drug and drug–disease interactions are also important.

Although several studies have found a positive association between body mass index (BMI) and stroke in men, the association in women is less clear. We evaluated women enrolled in the Women's Health Study and found that increased BMI was a strong risk factor for total and ischemic stroke. These results show that the number of total and ischemic strokes may be reduced if obesity is prevented.

The study by Kurth and Buring consisted of a prospective analysis among nearly 40 000 women participating in the Women's Health Study.

Depression at the time of coronary artery bypass graft (CABG) surgery is associated with a lack of functional benefits at 6 months after the surgery. These negative effects appear to be stronger for women than for men. Further research is needed to determine whether the treatment of depression after CABG surgery can improve outcomes. In the meantime, current guidelines recommend evaluation for symptoms of depression after CABG surgery and consideration of treatment for both men and women.

Mallik and Vaccarino remind us that heart disease kills more women than the next 7 causes of death combined.

A 36-year-old Hispanic man was diagnosed with type 1 diabetes in 1987 and dyslipidemia in 2001.

Increased serum lipid levels in diabetic pa­tients are associated with an increased risk of macular edema, retinal hard exudates, and secondary visual loss.