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Coronary heart disease in women: highlights of the past 2 years—stepping stones, milestones and obstructing boulders

Nature Clinical Practice Cardiovascular Medicine volume 3, pages 194–202 (2006)Cite this article

Abstract

Emerging data continue to highlight important sex-based differences in coronary heart disease (CHD) prevention and diagnostic testing, in the management of acute coronary syndromes and in the outcomes of CHD therapies. Evidence-based guidelines have been developed that offer specific recommendations for clinicians and information for women. These guidelines are buttressed by results that have become available from randomized, controlled clinical trials in women, and data from CHD registries and clinical trials involving both sexes but including adequate numbers of women to enable the reporting of sex-specific results. Underuse of guideline-based preventive and therapeutic strategies for women probably contributes to their less favorable CHD outcomes. Adherence to recommendations offers the promise of improving the heart health of women. In this article, I summarize new information to guide the preventive, diagnostic and therapeutic management of CHD in women.

Key Points

  • A misperception of lower cardiovascular risk status for women remains among physicians and correlates with suboptimum application of preventive interventions

  • Randomized, controlled trial data show no benefit from folic acid and vitamin E supplementation for CHD prevention, with possible harm from folic acid plus vitamin B6, and show no benefit from aspirin in reduction of a first major cardiovascular event, despite a reduction in ischemic stroke risk

  • Pretest likelihood of CHD, baseline electrocardiogram characteristics and ability to exercise are the major determinants of the choice of noninvasive tests in the diagnosis of chest pain in women

  • The CRUSADE Registry data challenge whether adverse outcomes in women with acute coronary syndromes relate to raised baseline risk, to suboptimum admission and discharge therapies, or both

  • An early invasive strategy with glycoprotein IIb/IIIa antagonist use is clearly recommended for women presenting with high-risk acute coronary syndromes

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Authors and Affiliations

  1. professor of medicine in the Division of Cardiology, Emory University School of Medicine, the Chief of Cardiology at the Grady Memorial Hospital, and a consultant, Emory Heart and Vascular Center, Atlanta, GA, USA

    Nanette K Wenger

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  1. Nanette K Wenger
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Competing interests

Nanette K Wenger has received research grants or contracts, or has served on research steering committees for Eli Lilly, AstraZeneca and Pfizer. She has served as a consultant in the following capacities: Eli Lilly Rloxifene Advisory Committee; Heart Disease in Women, MED-ED, Pfizer; Cardiology Consultant, Bristol-Myers Squibb; Ranolazine Advisory Board, Women’s Advisory board, CV Therapeutics; Sanofi-Aventis; Kos Pharmaceuticals WATCH Program; NitroMed Heart Failure Advisory Board; Leadership Council for Improving Cardiovascular Care (LCIC) Executive Committee, Schering Plough; and Coreg post MI Advisory Panel, GlaxoSmithKline. Dr Wenger is also a member of the Speakers Bureau (CME) for Pfizer, Novartis, Merck, Bristol-Myers Squibb, Eli Lilly and Nitro Med.

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Wenger, N. Coronary heart disease in women: highlights of the past 2 years—stepping stones, milestones and obstructing boulders. Nat Rev Cardiol 3, 194–202 (2006). https://doi.org/10.1038/ncpcardio0516

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