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Coronary artery disease: gender issues
Coronary artery disease (CHD) manifests itself on average ten years later in women than in men. Yet more women die from cardiovascular disease. There are several reasons for this.
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- Risk factors
- Starting positions
An existing CHD is diagnosed later in women than in men, mainly because cardiac catheter examinations - both to confirm and to rule out the disease - are carried out significantly later. This is due to the fact that the “classic” symptoms of angina pectoris are “less typical” in women and are also less often recognized as such by the doctors consulted and treated accordingly. The symptom of “heart and chest pain” is less likely to be associated with significant CAD in women. On the other hand, it takes longer for women with significant CHD detected in a cardiac catheter to “finally” receive an appropriate diagnosis and therapy.
To make matters worse, so-called non-invasive examinations to clarify CHD, such as ergometry, are less informative and reliable in women. It is important to focus on this. In any case, it means in women (even if the symptoms are not described "classically") to think about the presence of CHD and to initiate appropriate examinations earlier than too late.
Note Every woman who suffers from symptoms that could be associated with CAD should contact her general practitioner or a cardiologist at an early stage.
In principle, the risk factors for women and men are the same, especially:
- Family history,
- Lipid metabolism disorders,
- Diabetes mellitus,
- High blood pressure and
Especially in women over 35 years of age, the combination of oral contraception (“pill”) and smoking is a significant risk factor for CHD.
In principle, however, the risk factors are weighted differently for women and men. For example, diabetes in women (compared to non-diabetics) increases the risk of CHD significantly more than it does in men.
Note In women, coronary artery disease manifests itself as angina pectoris in approx. 50 percent and as sudden cardiac death in 17 percent. In men, both forms occur equally often with 33 percent each.
Women experience their heart attacks in a less favorable starting position than men. On average, they are around ten years older and at this point they often have additional (and long-standing) diseases such as diabetes mellitus, high blood pressure, lipid metabolism disorders and obesity. This constellation per se increases the likelihood of (fatal) complications associated with the heart attack. If the acute care of the infarct is carried out by means of thrombolysis, this leads to more complications in women (also in connection with the additional risk factors) than in men. Conversely, direct intervention on the occluded coronary vessel is carried out less frequently in women in acute infarction than in men, although in comparison they would benefit much more from it (especially in comparison to thrombolysis).