Heart Disease: What's the Difference between Men and Women?

When a patient is diagnosed with heart disease, cardiologists typically focus on treating him or her for obstructive coronary artery disease (CAD). However, an article published in the October 20 issue of the Journal of the American College of Cardiology explains that “up to half of women may not have” CAD. In fact, the authors proposed the term “ischemic heart disease” to classify women with heart disease instead of CAD for their review. The reason for this was because the problem many women deal with “is not obstruction in major heart blood vessels, but a reduction in blood flow, called ischemia, in very small arteries of the heart,” said C. Noel Bairey Merz, MD, director of the Women’s Heart Center at the Heart Institute at Cedars-Sinai Medical Center in Los Angeles.

Based on the clinical evidence review performed by Merz and colleagues, they found some major differences on how heart disease affects men and women:

1. More than 80% of midlife women have one or more traditional cardiac risk factors
2. Women have greater levels of blood cholesterol after age 50
3. Women have mild decreases in HDL after menopause
4. Women have higher levels of CRP

The authors learned that the “paradoxical sex differences observed across many studies have suggested that women have less anatomical obstructive CAD and relatively preserved left ventricular ejection function, but have greater rates of myocardial ischemia and mortality when compared with similarly aged men.” They expressed a need for continued research to “devise therapeutic regimens to improve symptom burden and reduce risk in women with ischemic heart disease.”