Coronary heart disease: an older woman's major health risk

Introduction

Coronary heart disease has traditionally been considered a problem which predominantly affects men—its extent and poor prognosis in women have only recently been identified. As shown in the Framingham study,1 women are more likely than men to die after myocardial infarction; this is now also evident after coronary artery bypass graft surgery and coronary angioplasty. However, the prognosis is currently also influenced by access to coronary diagnostic procedures and treatments, which may in turn be affected by factors such as women's and their doctors' decisions about diagnostic procedures and treatments, by the allocation of health care resources, and by society's perceptions of the importance of coronary heart disease in women.

Epidemiology

Coronary heart disease is more dependent on age in women than in men: women are usually 10 years older than men when any coronary manifestations first appear, and myocardial infarction occurs as much as 20 years later.1 One in 8 or 9 American women aged 45-64 years has clinical evidence of coronary heart disease and this increases to 1 in 3 in women older than 65 years (fig 1). Coronary heart disease is the leading cause of death in women in the United States; it is responsible for over 250 000 deaths annually (fig 2).2 With the aging of the population, more women than men now die of coronary heart disease each year in the United States.

A white postmenopausal woman in the United States is 10 times more likely to die of heart disease than of breast cancer.3 But most women do not understand the coronary threat. Studies show that women do not usually list heart disease among the health problems they consider most important.4 5 Morbidity from coronary heart disease in older women is also considerable; 36% of American women aged 55-64 …