Coronary artery disease in women.

OBJECTIVE: To review and recognize how presentation, investigation, risk factor modification, and treatment of coronary artery disease (CAD) is different for women than for men.

QUALITY OF EVIDENCE: Epidemiologic data are from well-recognized, peer-reviewed medical journals. Most data on treatment are from randomized controlled trials.

MAIN FINDINGS: Coronary artery disease is the leading cause of mortality in women, with incidence after menopause equal to that of men. Diabetes and postmenopausal status without hormone replacement therapy are the strongest risk factors. Women with CAD are more likely to have atypical symptoms, including nonexertional chest pain; pain in other locations, such as jaw, arms, shoulder, back, and epigastrium; and angina-equivalents, such as dyspnea, palpitations, and presyncope. Because women have atypical symptoms, physicians should maintain a high level of suspicion. Although newer nonivasive stress imaging modalities provide greater diagnostic accuracy than traditional exercise stress testing, the tests are still less accurate for women. A safe and cost-effective approach to investigation can be guided by clinical likelihood for CAD based on patients' age, chest pain quality, and risk factors. Treatment and preventive strategies are generally similar for women and men.

CONCLUSION: Coronary artery disease is a serious cause of morbidity and mortality in women and will continue to gain importance as women's life expectancy increases. Important differences in presentation, risk factors, investigation, and treatment of women exist and should be recognized.