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Coronary artery disease: Are men and women created equal?
Gender Medicine, 10/21/09

Blum A et al. – Results of the identified studies suggest that reduction of risk factors is a common approach to fighting heart disease in both sexes. It appears that for women, weight and BMI are not as important as previously thought, but physical exercise and fitness are very important and can change risk factors and clinical outcomes more than any other known intervention. Data suggest that global inflammation may play an important role in women and may predict cardiovascular outcome in women much better than the traditional risk factors that have been used and proved for men.

• The authors conducted a search of the PubMed database for double–blind studies on the mechanistic pathways of CAD in women published in English within the past 10 years and epidemiologic studies published since 1970.

• The literature search revealed 30 peer–reviewed articles pertaining to this issue.
• The incidence of CAD was markedly lower in women <60 years of age than in older women.
• After 60 years of age, the rate of CAD increased and reached the rate seen among men by the 8th decade of life.
• The gender difference in atherosclerosis in the coronary tree was particularly large in patients <55 years of age and remained large at older ages.
• The gender difference in the coronary bed was strikingly larger than in other vascular beds.
• Intensive risk–factor modification had a similar effect on plaque progression in both men and women.
• Coronary endothelial dysfunction appeared to be related to cardiovascular morbidity and mortality in women as well as in men, and because endothelial dysfunction could be modified, it appeared that the prognosis could be improved by appropriate management.
• A strong association was found between body mass index (BMI) and metabolic status, but only the metabolic syndrome was associated with CAD.
• Physical activity was independently associated with fewer risk factors, less CAD, and fewer adverse events in women; however, obesity was not associated with these outcomes.

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