Coronary artery disease in women: a review of emerging cardiovascular risk factors.

Coronary heart disease is the leading cause of death and disability in both men and women in industrial nations. From 1988 to 1998, the death rate from coronary heart disease actually declined 26.3%, resulting to some extent from the recognition and treatment of modifiable risk factors. The clinical observation that traditional risk factors for atherosclerosis cannot account for all patients who develop coronary heart disease or stroke has stimulated interest in reevaluating these factors and considering other determinants of pathogenesis. Our understanding of atherogenesis has evolved from a focus on lipid deposition within the arterial wall causing obstruction to the broader view of an inflammatory process which involves specific cellular and molecular responses to endothelial dysfunction. As a consequence, emerging cardiovascular risk factors and preventive strategies have been proposed. For example, there is an increasing understanding of the pathology of hypercholesterolemia and the benefits of lipid-lowering medications (specifically statins), the role of oxidative stress, and antioxidant, homocysteine, and hypercoagulable states. This review examines the data for these and other emerging risk factors, with specific attention to gender differences.