Therapy for coronary heart disease in women.

Both the presentation and prognosis of coronary heart disease in women are significantly different than in men. Diagnostic evaluations should be approached somewhat differently in male and female populations, and gender should be one of the variables assessed when options for medical and surgical therapy are considered. Risk factor modification can be offered as a potentially effective form of therapy for coronary heart disease in women. These modifications would include cessation of smoking, avoidance of oral contraceptives in women greater than 35 years of age, hypertension control, and normalization of blood lipid profile and body weight. Risk factor modification may be particularly important in prevention of accelerated atherosclerosis in diabetic women. Prognosis after myocardial infarction is significantly worse in women despite better post-infarction left ventricular ejection fraction and higher incidence of non-Q-wave myocardial infarction in that population. Definitive assessment of coronary anatomy and aggressive management of coronary heart disease should be considered in women judged to be at high risk. Little information is available regarding gender-specific responses to medical management of coronary heart disease. Women seem to have a less favorable short-term outcome after PTCA, but better long-term results. Coronary artery bypass grafting results appear to depend less on gender than on coronary anatomy, preoperative risk factors, and patient size, and thus should not be withheld from women.