CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN VS. MEN : DIFFERENCES IN PRESENTATION, TREATMENT AND OUTCOME Prof. Dr. Christian BROHET Cardiology UCL November 2007
CVD IN WOMEN : THE FACTS (1 ) • Ischemic heart disease : 3-4x more frequent in men between 25 and 74 years (less difference for stroke). • Difference is reduced with aging (around menopause), minimal in very old persons. • On the average, women are affected 10 years later than men.
CVD IN WOMEN : THE FACTS (2) • USA : myocardial infarction + stroke kill about 500.000 women each year = almost twice the deaths caused by all cancers (breast cancer included). • EU : causes of death Women Men CHD 23% 21% STROKE 18% 11% OTHER CVD 15% 11% • BELGIUM : ischemic heart disease is responsible for 13% of all deaths in men, 11% in women.
CVD IN WOMEN : THE FACTS (3 ) • In Europe, 55% of women will die of CVD as opposed to 43% of men. • After AMI, death rate is higher in women than in men (55% vs 49%). • During her lifespan, a woman has a 10% risk of having a breast cancer and a 3-4% risk of dying from it, whilst she has a 50% risk of dying from an AMI or a stroke.
STROKE IN WOMEN • Overall incidence of stroke higher in men than in women but increases with age in both genders. • Incidence of ischemic stroke in persons with a history of TIA is higher in women than in men. • Over an entire lifetime, about 16% of women will die of stroke, whereas only 8% of men will die of stroke Circulation 1997 ; 96 : 2468-2482
CHD IN WOMEN : DIAGNOSTIC & THERAPEUTIC PROBLEMS • Chest pain • Syndrome X • Non invasive diagnostic tests • PCI & CABG
PCI IN WOMEN (1) • In the US, only about 33% of annual PCIs are performed in women. • Women experience greater delays and have less diagnostic cath. than men. • Women have greater risk profils, are older and have more risk of procedural complication, but there might be a potential sex bias. • In contrast, once women are referred for cardiac cath., revascularisation rate and practices are similar to those in men : « anatomy is destiny ». Circulation 2005 ; 111 : 940-953
Non fatal and and fatal fatal myocardial infarction myocardial infarction* * Non fatal in men men (35 (35- -74 74 years years) MONICA ) MONICA- -BELLUX BELLUX in 34 % 34 % Fatal, out of hospital hospital Fatal, out of Fatal, in hospital hospital Fatal, in 51 % 51 % Non fatal (NF1) Non fatal (NF1) 15 % 15 % * first events first events, 85 , 85- -03 03 *
Non fatal and and fatal fatal myocardial infarction myocardial infarction* * Non fatal in women women (35 (35- -74 74 years years) MONICA ) MONICA- -BELLUX BELLUX in 35 % 35 % Fatal, out of hospital hospital Fatal, out of Fatal, in hospital hospital Fatal, in 45 % 45 % Non fatal (NF1) Non fatal (NF1) 20 % 20 % * first events first events, 85 , 85- -03 03 *
CVD IN WOMEN « It has been suggested that gender differences in mortality related to CHD no longer exist after adjustment for differences in age, risk factors, and interventions. Although this may be important from an explanatory point of view, from the perspective of public health the fact remains that women have a worse prognosis and die more often than men after a heart attack or a bypass surgery » Circulation 1997 ; 96 : 2468-2482
PCI IN WOMEN (2) • Need for improving referral for early therapy. • Need for optimizing therapy for patients with diabetes and small vessel CAD. • Need for refining treatment pathways and strategies for women with STEMI, in whom mortality rates and bleeding risk remain higher than in men. Circulation 2005 ; 111 : 940-953
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