HHS Public Access Author manuscript Author Manuscript
Circ Res. Author manuscript; available in PMC 2017 April 15. Published in final edited form as: Circ Res. 2016 April 15; 118(8): 1273–1293. doi:10.1161/CIRCRESAHA.116.307547.
Cardiovascular Disease in Women: Clinical Perspectives Mariana Garcia, M.D.1, Sharon L. Mulvagh, M.D.1, C. Noel Bairey Merz, M.D.2, Julie E. Buring, Sc.D.3,4, and JoAnn E. Manson, M.D, Dr.P.H.3,4 1Division
of Cardiovascular Diseases, Mayo Clinic, 200 First Street S.W. Rochester, MN 55905
2Barbra
Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, 27 S. San Vicente Blvd, A3212, Los Angeles, CA 90048
Author Manuscript
3Division
of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215 4Department
of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
Abstract
Author Manuscript
Cardiovascular disease (CVD) continues to be the leading cause of death among women in the United States, accounting for approximately one of every three female deaths. Sex-specific data focused on CVD has been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex-differences as they relate to clinical practice in the prevention, diagnosis, and treatment of CVD. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including: myocardial infarction associated with non-obstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other CVD entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease and abdominal aortic aneurysms, are also briefly reviewed. Lastly, recommendations for cardiac rehabilitation are addressed.
Keywords Primary Prevention; Women; Risk Factors; Cardiovascular Disease; Acute Coronary Syndromes
Author Manuscript
Subject Terms Cardiovascular Disease; Women; Risk Factors; Prevention
Corresponding Author: JoAnn E. Manson, M.D, Dr.P.H., Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215 & Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115. Phone: 617-278-0871; Fax: 617-731-3843; [email protected]. Disclosures None.
Garcia et al.
Page 2
Author Manuscript
I. Introduction
Author Manuscript
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 2013.1 For the past three decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the >65 age group. However, recent data suggest stagnation in the improvements in incidence and mortality of coronary heart disease, specifically among younger women (80 years have a blood pressure (BP) 90%; Intermediate 10–90%, Low
Circ Res. Author manuscript; available in PMC 2017 April 15. Published in final edited form as: Circ Res. 2016 April 15; 118(8): 1273–1293. doi:10.1161/CIRCRESAHA.116.307547.
Cardiovascular Disease in Women: Clinical Perspectives Mariana Garcia, M.D.1, Sharon L. Mulvagh, M.D.1, C. Noel Bairey Merz, M.D.2, Julie E. Buring, Sc.D.3,4, and JoAnn E. Manson, M.D, Dr.P.H.3,4 1Division
of Cardiovascular Diseases, Mayo Clinic, 200 First Street S.W. Rochester, MN 55905
2Barbra
Streisand Women’s Heart Center, Cedars-Sinai Heart Institute, 27 S. San Vicente Blvd, A3212, Los Angeles, CA 90048
Author Manuscript
3Division
of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215 4Department
of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
Abstract
Author Manuscript
Cardiovascular disease (CVD) continues to be the leading cause of death among women in the United States, accounting for approximately one of every three female deaths. Sex-specific data focused on CVD has been increasing steadily, yet is not routinely collected nor translated into practice. This comprehensive review focuses on novel and unique aspects of cardiovascular health in women and sex-differences as they relate to clinical practice in the prevention, diagnosis, and treatment of CVD. This review also provides current approaches to the evaluation and treatment of acute coronary syndromes that are more prevalent in women, including: myocardial infarction associated with non-obstructive coronary arteries, spontaneous coronary artery dissection, and stress-induced cardiomyopathy (Takotsubo Syndrome). Other CVD entities with higher prevalence or unique considerations in women, such as heart failure with preserved ejection fraction, peripheral arterial disease and abdominal aortic aneurysms, are also briefly reviewed. Lastly, recommendations for cardiac rehabilitation are addressed.
Keywords Primary Prevention; Women; Risk Factors; Cardiovascular Disease; Acute Coronary Syndromes
Author Manuscript
Subject Terms Cardiovascular Disease; Women; Risk Factors; Prevention
Corresponding Author: JoAnn E. Manson, M.D, Dr.P.H., Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02215 & Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115. Phone: 617-278-0871; Fax: 617-731-3843; [email protected]. Disclosures None.
Garcia et al.
Page 2
Author Manuscript
I. Introduction
Author Manuscript
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 2013.1 For the past three decades, dramatic declines in heart disease mortality for both men and women have been observed, especially in the >65 age group. However, recent data suggest stagnation in the improvements in incidence and mortality of coronary heart disease, specifically among younger women (80 years have a blood pressure (BP) 90%; Intermediate 10–90%, Low
