Diagnosing heart disease in women is difficult. About five hundred thousand women in the U.S. die from CAD (coronary artery disease) every year. It is the leading killer of women in the US. Its diagnosis is often missed or delayed.  More women than men have diabetes, hypertension, elevated cholesterol, and family history of CAD. Women with angina (chest pain) are less likely than men to be referred for testing and treatment.  In addition, women have other health conditions that could obscure CAD symptoms and delay diagnosis. This includes abdominal pain, difficulty breathing (dyspnea), nausea, and fatigue.Health providers may attribute women’s chest pain to other causes, such as stress and heartburn.

  Risk factors CAD in women  Cigarette smoking in young women is a powerful risk factor for CAD. Smoking cessation dramatically reduces CAD risk. After fifty five years of age, women's cholesterol and lipid levels increase. Hypertension (elevated blood pressure) increases with age in both men and women. However, after age fifty, more than two times as many women as men develop hypertension. Elderly women outnumber elderly men. There are more hypertensive women than hypertensive men in the US. 

  Diabetes is a powerful risk factor for CAD in women, more so than for men. Diabetes is linked to obesity, hypertension, and elevated cholesterol.Women have a positive family history for CAD more often than men. Use of low-nicotine-yield cigarettes does not decrease CAD risk. They provide a false sense of security.

  Hypertension increases with age in both men and women. After age fifty, more than two times as many women develop hypertension compared to men. Since elderly women outnumber elderly men, there are more hypertensive women than hypertensive men in the US. A healthy diet, smoking cessation, and periodic exercise reduce CAD risk.

  HRT (hormonal replacement therapy) might be considered for women with multiple CAD risk factors. HRT after menopause decreases CAD risk. Oral estrogen raises HDL (the good lipid) and lowers LDL (the bad lipid) by twenty to thirty percent. However, it should be prescribed carefully in women with breast cancer, family history of breast cancer, or uterine cancer. 

  Diagnostic testing: Exercise Electrocardiography is the most researched test to diagnose CAD in women. It is accurate for those who can exercise to an eighty five percent predicted heart rate.However, the results may be less accurate in women than in men. 

  Echocardiography, a non-invasive test, images heart tissue and heart valves without radiation. It takes about thirty minutes to perform. It could be difficult to interpret in women with lung disease or obesity. 

 “Researchers in the U.K. have developed a vegetable called ‘super broccoli’ designed to fight heart disease. Not to be outdone, researchers in America have developed a way to stuff an Oreo into another Oreo.” Jimmy Fallon. 

Source:   http://www.medscape.com/viewarticle/722326

Questions or comments? Contact Dr. Clem at clementhanson.blogspot.com