RSS Feeds
Coronary Artery Disease in Young Women: The Menstrual Cycle and Other Risk Factors
Coronary artery disease is the leading cause of death in men and in women (1), and over the past several years, increasing medical attention has been given to coronary artery disease in women. The differences between women and men in the presentation and natural history of coronary artery disease are multiple. Coronary artery disease generally presents at least 10 years later in women than in men. Angina is typically the first clinical symptom in women, whereas myocardial infarction is usually the first clinical symptom in men (1). Unfortunately, U.S. women still are more concerned about their risk for breast cancer than their risk for heart disease (2).
The National Myocardial Infarction Registry 2 (3) revealed that whereas U.S. men were more likely than women to have a myocardial infarction before 50 years of age, women's risk for death after admission was higher. As demonstrated in trials and observational studies of myocardial infarction, women present for care approximately 1 hour later than men, and this time delay affects the patients' eligibility for thrombolytic therapy (1). Therefore, further public education is clearly needed. Aggressive therapy is most often considered for younger rather than older patients; thus, men are usually the beneficiaries of such treatment.
Because the prognosis for women with coronary artery disease appears to be less benign before the age of 50 years, the potential significance of endogenous hormones related to the menstrual cycle becomes more important to consider.
Since the average age of menopause is 51 years, many women who have coronary artery disease are still menstruating (1). Of interest, tobacco use is associated with earlier menopause (1). The effect of the menstrual cycle on the presentation and management of coronary artery disease has been examined substantially less than the effect of hormonal use …
