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Chapter 108: Women and Ischemic Heart Disease: An Evolving Saga

Which of the following statements about women and ischemic heart disease is false?

A. Women have greater CVD mortality than men

B. Despite reporting more disability, women report better quality of life than men

C. Women present later and with more comorbid conditions than men

D. Women receive fewer medical therapies and fewer interventions than men

E. The underuse of guideline-based preventive and therapeutic strategies for women is a substantial contributor to their less favorable coronary outcomes

The answer is B. (Hurst’s The Heart, 14th Edition, Chap. 108) Women have greater CVD mortality (option A) and report more disability and decreased quality of life (option B). They present later and with more comorbid conditions (option C) yet receive fewer medical therapies and fewer interventions than men (option D), contributing to sex-specific gaps in outcomes. These differences probably reflect both lingering diagnostic and treatment disparities and underlying biological differences. The underuse of guideline-based preventive and therapeutic strategies for women is a substantial contributor to their less favorable coronary outcomes (option E), but the spectrum of sex differences likely reflects a combination of biology and bias.

A 60-year-old woman presents to your clinic complaining of a burning sensation in her chest at rest, which radiates down her arm. Which of the following statements concerning the development or manifestation of heart disease in women is correct?

A. Obstructive atherosclerotic disease of the epicardial coronary arteries remains the major cause of acute myocardial infarction (MI) for women

B. Plaque characteristics differ for women, with recent data suggesting a greater role of macrovascular disease and obstructive coronary artery disease (CAD) in the pathophysiology of coronary events in women

C. Women have more severe obstructive CAD at angiography than men

D. Both A and C are correct

E. All of the above are correct

The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 108) The term ischemic heart disease (IHD) is advantageous for women because of women’s lower prevalence of anatomic obstructive CAD, despite greater myocardial ischemia and associated mortality when compared to men.1-3 Although obstructive atherosclerotic disease of the epicardial coronary arteries remains the major cause of acute MI for women (option A), symptomatic women with myocardial ischemia remain at risk even with no or minimal epicardial CAD.4 Sex differences in nonobstructive CAD are an area of active investigation. Plaque characteristics also ...

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