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Coronary Artery Disease: Gender-Specific Differences
 With Coronary Artery Disease (CAD) being the number one killer of all
individuals in Kentucky as well as the United States, the Center for Gender-Specific
Differences at Jewish Hospital Medical Center East is particularly interested
in initiating research projects focusing on the area of cardiovascular
health. Key statistics that are already known include:
- Cardiovascular disease kills more women than all cancers combined.
For men and women, CAD is the most important of all the illnesses that
threaten our lives. CAD results when a waxy substance called plaque
(composed of cholesterol, clots, and other debris) accumulates in the
arteries that supply the heart with blood. Plaque narrows the width
of the artery, and the flow of blood diminishes. If not enough blood
reaches the heart tissue to supply it with the energy it needs, a portion
of it dies. This is a heart attack, or myocardial infarction.
- Until the 1990's, almost all the information we had about the cardiovascular
system came from studies performed on men alone.
- 500,000 women die each year of cardiovascular disease. Half of them
die of CAD, and 100,000 of those deaths are premature.
- Women's Coronary Artery Disease is more likely to be managed by medication
than by more aggressive intervention.
- Women's hearts are smaller than those of men
- Normal women are more likely than men to develop early or premature
beats and even prolonged periods of very rapid abnormal beating. Certain
features of the EKG are normally different in males and females as soon
as children achieve puberty.
- In one study of women with arrhythmia, 59% of patients reported that
these periods of abnormal rhythm were associated with hormonal shifts
and 41% felt that hormonal shifts were the only precipitating factor.
Estrogen can make the heart susceptible to abnormal rhythms; it intensifies
the sensitivity of the heart to input from the sympathetic nervous system.
- Women are more likely to suffer sudden cardiac death than men during
anti-arrhythmic therapy.
- Hypertension or high blood pressure is associated with stroke in 59%
of women, but only 39% of men.
- 25% of all the people in the world have high blood pressure, and about
60% of them are women.
 Do Women and Men experience Coronary Artery Disease in the same way?
The risk factors and warning signs for Coronary Artery Disease are generally
the same for men and women, but there are also important differences:
- Serum Lipid levels - HDL levels of 35 are not as concerning for men,
women begin to have increased risk for CAD below levels of 45 mg/dl.
- For men, triglyceride levels can go as high as 400 mg/dl of blood
without an increased risk of CAD; for women, optimal levels are under
200 mg/dl.
- Diabetes – Diabetic women are 4-6 times more likely to develop
CAD, while men are only 2 times more likely.
- Age – CAD begins to be more apparent in men by age 35; the disease
is usually not symptomatic in women until age 45.
- Hypertension – Before menopause, women's blood pressure is lower
than that of same-age men, but as women age, their blood pressure increases
at a faster rate than that of men.
- Obesity – Being 30% over ideal body weight increases the risk
of both sexes for CAD. Men have greater risk than women at any given
weight.
- Family History – Having a first-degree relative (mother, father,
sister, or brother) who dies of CAD before the age of 55 increases the
risk for CAD in both men and women. For women, the risk is more serious
if the relative is female.
- Menopausal state – Menopause alone does not make women more likely
to have CAD.
- Smoking – One cigarette a day increases risk of CAD for both
sexes.
- Lack of exercise – Walking briskly for forty minutes a day three
times a week can reduce the risk of CAD by 40%.
- Stress – Causes an increase in heart rate and blood pressure
for men and women
Testing for CAD: 
- Women are more accurately tested with stress echocardiogram or stress
myocardial perfusion imaging.
Clinical Symptoms of a heart attack:
- Sensation of burning pain or pressure in the center of the chest
- Pain may radiate down the left arm or down both arms and into the
neck and jaw.
- 20% of women have symptoms that are quite different: pain in the upper
abdomen or back, intense shortness of breath, nausea, and profuse sweating.
Women are often misdiagnosed with indigestion or a gallbladder attack.
Shortness of breath may be interpreted as an anxiety attack.
The first heart attack is much more dangerous for women than men:
- 39% of women will die within the first weeks after their first heart
attack, as compared with 31% of men.
- Women are also more likely to have a repeat heart attack within the
following years.
- More females than males suffer from depression after a heart attack.
- Woman are less likely than men to be able to return to their normal
pre-attack lifestyles and are less likely to resume sexual activity.
The most important gender-specific differences in coronary artery
disease for women:
- Symptoms of an acute heart attack in one out of five women are not
classic, but involve stomach pain, excessive sweating, and extreme shortness
of breath.
- Diabetes is probably the most important risk factor for a woman; it
removes any protection a woman has by virtue of her age or premenopausal
state.
- After a myocardial infarction, women are much less likely than men
to receive optimal therapy, which should include a beta-blocker, ACE
inhibitor, an aggressive lowering of LDL cholesterol levels to below
100 mg/dl, and a daily aspirin.
- Recent data suggest that women with established CAD should not be
started on hormone replacement therapy. But women who were on HRT before
they developed CAD can safely continue it.
- The waist-hip ratio is a more accurate indicator of risk for CAD than
the body mass index. Be sure to ask you doctor to measure it for you,
and if you have to lose weight, follow its improvement. (It should be
0.8 or less).
- Correct poor lifestyle habits:
- Stop smoking
- Pursue a reasonable and consistent exercise program
- Reduce stress in your life
For more information on the Gender-Specific differences of cardiovascular
health, please call the Center for Gender-Specific
Medicine at (502) 259-6414.
 Click here to view
the pdf version of the Gender-Specific Differences of Cardiovascular Health
poster.
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