A new review of coronary artery disease (CAD) looks at the gender-specific differences of CAD-related issues and reveals that women are older than men at CAD onset, have different pathophysiologic features than men, and suffer higher mortality than men. The research was published July 28 in Global Heart.

CAD is the leading cause of death in men and women in the U.S. However, it was long thought to be a “man’s disease” and only in recent years has the impact of CAD on women been recognized and studied. The authors note that women are on average 10 years older than men at CAD onset and suffer a higher CAD-related mortality rate. They also look at gender-specific differences in CAD pathophysiology, including the higher burden of microvascular disease in women than men. They note that women have unique risk factors for CAD, including those related to pregnancy and autoimmune disease. “Traditional risk factors such as age, family history of CAD, hypertension, diabetes, dyslipidemia, smoking and physical activity are important predictors of risk in women,” they add.

They discuss the diagnosis and gender-specific treatment strategies for obstructive and nonobstructive CAD and note that trial data indicate that CAD should be managed differently in women. “The Duke treadmill score, which incorporates exercise time, ST-segment deviation, and an angina score, is particularly useful in women and performs better in women than in men for predicting significant CAD,” they add.

Lastly, the authors addresses the lessening, but nevertheless pervasive, undertreatment of women, explaining that “women are less likely to receive preventive recommendations, such as lipid-lowering therapy, aspirin and lifestyle advice … less likely to have their blood pressure at goal … less likely to be treated to reach goal for low-density lipoprotein cholesterol,” among other disparities.

“The manifestation of CAD has unique characteristics in women. Increasing data demonstrate that some treatment strategies have sex-specific effectiveness,” note the authors. Moving forward, the authors conclude that “further research regarding the pathophysiology of CAD in women, diagnosis and treatment strategies specific to women is required.”

Keywords: Cause of Death, Cholesterol, Dyslipidemias, Coronary Artery Disease, Motor Activity, Risk Factors, Autoimmune Diseases, Hypertension, Diabetes Mellitus, Smoking