Is there a difference in the extent of CAD in females compared to males?

Yes. As a subset study in CASS, Chaitman et al. showed less extensive left main and triple-vessel CAD in women as compared to men in coronary angiography studies. Women also retained angiographic systolic function to a greater extent, suggesting a resistance to developing chronic left ventricular dysfunction and heart failure.

Do women fare as well as men post heart transplantation?

Although this issue has not been studied well, the Italian Multicenter Study Group followed 65 women and 238 men with documented idiopathic cardiomyopathy. Though the women presented with a more advanced phase of the diseaseâ”i.e., more dilated left ventricles, thicker left ventricular walls, shorter exercise duration, and worse symptomsâ”the 18-month follow-up transplant-free survival was not significantly different by gender, and there was no difference in prognosis. Therefore although women presented with more symptomatic disease after transplant, they did equally well as men.

Should women be treated differently than men for CAD?

There is little information available comparing the efficacy of medical management for CAD by gender. In two studies, the protective effects of P-blockers and aspirin as secondary prevention of CAD were shown not to extend to women, whereas one study showed a regimen of 1-6 aspirin/week decreased the risk of the first myocardial infarction in women. Recent studies show success of percutaneous transluminal coronary angioplasty is no longer adversely influenced by female gender. Coronary artery bypass surgery in women is associated with an increased operative mortality, perhaps related to smaller vessels, and vein graft (including the internal mammary artery) patency is less at 5 years (87-97% survival in women vs. 90-94% in men). These differences post-bypass, however, disappear at 10-year follow-up studies.

1Diabetes is an important risk factor for CAD. Are there gender differences in risk when diabetes and CAD coexist?

In a study of 585 men and 389 women with CAD assessed by angiography, diabetic women had greater than two times the relative risk of death over a 4-6-year follow-up for all causes of death as well as cardiac death; whereas in nondiabetic patients, death was significantly lower in women. Therefore, diabetes confers a substantially higher risk of mortality in women when it coexists with CAD than in men, and the favorable cardiac risk profile premenopausal women have compared to men is lost in the presence of diabetes. Hypertriglyceridemia may also be of greater risk for women than men.

How does estrogen replacement affect the risk of atherosclerosis and myocardial infarction in postmenopausal women?

Estrogen reduces the risk of atherosclerosis and myocardial infarction in postmenopausal women. There is a reduction of up to 50% in myocardial infarction and stroke and a reduction in the incidence of hypertension.

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