CORONARY ARTERY DISEASE IN WOMEN- HOW DOES IT …
CORONARY ARTERY DISEASE IN WOMEN - HOW DOES IT DIFFER FROM MEN
K.A. Adarsh
Govt Medical College, Amritsar, India
Cardiovascular disease is the leading cause of death in both women and men. In women coronary artery disease (CAD) presents approximately 10 or more years later & the disease is comparatively more severe. It remains underdiagnosed and undertreated especially in Indian women. The clinical presentation is atypical the usual symptoms being chest discomfort, breathlessness, nausea & vomiting. Women presenting with CAD are more likely to have a history of diabetes mellitus, hypertension, obesity and hyperlipidemia. In women atherosclerosis usually involves the entire circumference of the artery diffusely with a lower prevalence of luminal obstruction. Compared with men, women have worse outcomes once they present with obstructive coronary disease. Multivessel disease is common among Indian women. Morbidity & mortality rates in women for coronary bypass surgery, angioplasty and stenting are higher. In younger woman with myocardial infarction (MI), the mortality rate is approximately twice as compared to men. Men are more likely to have elevated creatine kinase MB and troponins, whereas women are more likely to have elevated C-reactive protein and BNP. Pathophysiologically the role of microvascular dysfunction , hypoestrogenemia and inflammation has been highlighted in women. Sensitivity and specificity of stress testing to predict coronary disease are significantly lower in women. Appropriate noninvasive tests( like cardiac MRI, SPECT etc) should identify not only those with obstructive CAD but also the subset with normal coronary arteries who are at increased risk of cardiovascular event. Benefits of taking aspirin are slightly lesser in women and harm from HRT outweighs its benefits.[pic]
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