Women and CVD

Question 1

General Trends

Answer 1

• More female CVD deaths per year BUT at greater age (inc around 65+)
• Present 8-10 yrs later than men (likely b/c estrogen is protective then no estrogen once menopause)

Question 2

Role of Estrogen

Answer 2

• Dec LDL, inc HDL, inc TGs
• Inc vasodilation by inc available NO
• Inhibit response to vessel injury by inc endothelial growth/ dec smooth muscle growth

**Protective then gone after menopause

Question 3

3 Female Specific Risks

Answer 3

• Autoimmune diseases (SLE or RA) more common in women and like to premature atherosclerosis; INFLAM
• OBGYN hx - preeclempsia, gestation diabetes, polycystic ovarian syndrome
• Thoracic radiation for breast cancer inc risk of cardiac event

Question 4

How does acute coronary disease differ in women?

Answer 4

• Women more likely to present w/ atypical symptoms (referred pain, SOB, nausea, unexplained fatigue, palpitations)
• Leads to bias in tx - less likely to tests, less screening, less prescriptions
• Greater instance of dying from CHD w/o prior symptoms than men (64%)
• Greater instance of dying both 1 yr and 5 yrs post MI
• Chest pain w/ “normal coronary arteries”

Question 5

Chest Pain w/ “Normal Coronary Arteries”

Answer 5

• Still at risk for cardio event (2x more likely to have cardiac event than those w/ no CAD but also no chest pain)
• Poss mechanisms - vasospasm, endothelial dysfunction (abnormal blood flow response to vasoactive compounds in inflammation), inc sympathetic tone so small vessels at baseline

Question 6

4 Drugs Contraindicated for Prim/Sec CVD Prevention in Women

Answer 6

antioxidants
folic acid
SERMs
hormone replacement therapy