Cardiovascular disease in women: Sex differences in presentation, risk factors, and evaluation

Cardiovascular disease (CVD) is the leading cause of mortality in women. Pathophysiology, risk factors, clinical presentation, and outcomes of coronary artery disease (CAD) differ in women, and a better understanding of the sex differences in these factors will potentially lead to a slowing of this epidemic in women. Often forgotten, women have higher complication rates post revascularization and higher in-hospital mortality post myocardial infarction compared with men despite a smaller burden of disease in women. Though overall women share the same risk factors as men in the development of CAD, certain risk factors appear to be particularly ominous, such as the presence of diabetes mellitus, low values of high-density lipoprotein cholesterol, high triglycerides, and psychologic depression. Disease detection in advanced CAD is more accurate with stress echocardiography (ECG) and perfusion single-photon emission computed tomography imaging in women than with stress ECG. Subclincial atherosclerotic disease detection with carotid artery intima media thickness assessment provides an opportunity to target preventive measures in women. This article focuses on some of the sex-specific differences.