Cardiovascular Disease in Women

Cardiovascular disease (CVD) remains the leading cause of death in women and, according to the most recently released United States statistics, accounted for 398 086 female deaths in 2013. For the past 3 decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the >65 years age group. However, recent data suggest stagnation in the improvements in incidence and mortality of coronary heart disease, specifically among younger women (<55 years). It is imperative that we understand the mechanisms that contribute to worsening risk factor profiles in young women to reduce future atherosclerotic cardiovascular disease (ASCVD) morbidity and mortality. Increased recognition of the prevalence of traditional ASCVD risk factors, and their differential impact in women, as well as emerging, nontraditional risk factors unique to or more common in women, contribute to new understanding of mechanisms leading to these worsening outcomes for women (Figure 1). Finally, diagnosis of acute coronary syndromes (ACS) is often challenging in women, especially young women, and it is important to recognize differences in the signs and symptoms at presentation to improve patient management and outcomes. Awareness of CVD as the primary cause of mortality in women has been slowly increasing. In 1997, only 30% of American women surveyed were aware that CVD was the leading cause of death in women; this increased to 54% in 2009 and has subsequently plateaued when last surveyed in 2012. Women are less likely to receive preventive treatment or guidance, such as lipid-lowering therapy, aspirin (ASA), and therapeutic lifestyle changes, than are men at similar ASCVD risk. When medications are prescribed, treatment is less likely to be aggressive or to achieve optimal effects, for example, women with hypertension are less likely to have their blood pressure (BP) at goal, and hyperlipidemic women, especially those with coexisting diabetes mellitus (DM), are less likely to be treated with statins to lower low-density Review