Chapter 4

### INTRODUCTION

Cardiovascular disease (CVD) remains the leading cause of death in women.1 Nearly half-a-million women die each year in the United States from ischemic heart disease (IHD) and its related conditions with the most recent annual statistics on mortality reporting that CVD accounted for 421,918 deaths among women in the United States.2 In fact, current projections indicate this number will continue to rise with our aging population2,3,4 (Figure 4-1). Since 1982 more women than men have died annually from IHD2 (Figure 4-2), which is the leading killer of women with annual mortality rates exceeding those due to breast cancer in women of any age2,5 (Figure 4-3). Although in the last decade, there have been significant declines in female mortality due to coronary heart disease, these reductions lag behind those seen in men1 (see Figure 4-2). In addition, women under 65 suffer the highest relative sex-specific cardiovascular heart disease mortality (Figure 4-4). A study from the Journal of American Clinical Cardiology in 2007 noted that although mortality from coronary heart disease (CHD) in men across all age groups has decreased, there has been a notable increase in mortality among women belonging to youngest age group (<55 years).6 This group of women, in particular, also have increased risk factors for CHD.6 Additionally, women were more likely to die of cardiac arrest before hospital arrival compared to men, 52% and 42% respectively.3 This prehospital death rate represents a worsening trend among women and a significant change from prior decades.7,8 Though there have been declines in sudden cardiac deaths in men, the condition of women has changed little9 (Figure 4-5), even those who are living with cardiovascular disease suffer greater morbidity and mortality than men. Upon examination of the specific diagnoses of CVD and comparison of their effects on gender, it has been proved that women not only suffer greater mortality, but greater morbidity as well. When compared with men, women suffer 2 times greater mortality and morbidity from angina and coronary artery bypass graft surgery (CABG).10 There is a 2 times greater incidence of congestive heart failure (CHF) and 1½ times greater 1-year mortality from myocardial infarction (MI) in women than men.10 Lastly, women with proven coronary artery disease (CAD) but stable angina have a higher probability of death or MI than men11 (Figure 4-6).

###### FIGURE 4-1

Cardiovascular disease (CVD) and other major causes of death: total, <85 years, and ≥85 years. Deaths among women, United States, 2007. Abbreviations: CLRD, chronic lower respiratory disease.2 National Center for Health Statistics and National Heart, Lung, and Blood Institute.

###### FIGURE 4-2

Cardiovascular disease mortality trends for males and females (United States: 1979-2007). The overall comparability for cardiovascular disease between the International Classification of Diseases, 9th Revision (1979-1998) ...

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