Womens heart health series: A mini-symposium

Coronary artery disease is the leading cause of death for both men and women in the United States. While its incidence in men has been long appreciated, the impact on women has been underestimated for many years. This is in part because coronary artery disease generally appears later in women, the incidence increasing after the onset of the female menopause. There are approximately 8 million women living with heart disease in this country; almost 400.000 died from it in 1999 compared to almost 42.000 from breast cancer. Yet many women feel that cancer is more likely to be a cause of mortality. This review examines the common misperception of the prevalence of coronary artery disease in women and examines contributing risk factors such as hypertension, elevated serum cholesterol, diabetes mellitus and cigarette smoking. It considers access to care and diagnosis, both non-invasive and invasive, of coronary artery disease specifically as it pertains to women. Treatment options, ranging from medical management, through cardiac catheterization and percutaneous catheter based intervention, to coronary artery bypass surgery are discussed. In addition is included a section addressing the controversial issue of estrogen and its role in the incidence and treatment of heart disease in women.