The issue of coronary heart disease in women has received much attention lately. Women are unfortunately not at all immune from heart disease, and in fact heart disease is the most common cause of death in women in Western society. Women do have a lower likelihood of developing heart disease in their middle years, especially before menopause. Over time, however, the chance of developing heart disease in women increases to approach that of men by their eighth decade of life.
Since women are protected from coronary artery disease to a large extent by the presence of female hormones (largely estrogen), they tend to be somewhat older than men when they first develop the signs and symptoms of heart disease, and they tend to be more likely to have coexisting illnesses that can contribute to coronary heart disease, especially diabetes. For this reason, the typical female patient first develops heart-related problems when she is older; as well, she is more likely to have high blood pressure and diabetes, and to be somewhat sicker than her male counterpart. This reason accounts for most of the apparent differences between men and women who have coronary heart disease, as opposed to some special biology of heart disease in women. Largely because of these differences in underlying disease, women tend to have symptoms that are more often unusual, such as nausea, a generalized feeling of being unwell or breathlessness, rather than chest pain, or discomfort, and they are likely to have more serious heart disease when first diagnosed. Whether it is because of these factors or because female patients are less attuned to the possibility that they may have heart disease, women do take longer to go to their doctors or to the hospital at the first sign of coronary heart disease symptoms or a heart attack. Although it is controversial whether they are as likely to undergo extensive testing as men, it is important for female patients and their families to be aware of the possibility of heart disease, and to seek medical care promptly if they have unusual symptoms of severe fatigue, breathlessness, chest discomfort or other disabling symptoms, especially if they have a history of high blood pressure or diabetes.
Once a diagnosis of coronary heart disease is made, women are usually treated just as carefully and thoroughly as men, although their prognosis is unfortunately not as good as the average man's; as noted above, this is the case because they are likely to be older and somewhat sicker at the time that the illness first occurs.
The question of whether estrogen, taken in tablet form or through a skin patch, can prevent or protect from the development of heart disease in women after menopause remains unanswered. A considerable body of research suggests that those women who take estrogen are less likely to develop coronary heart disease, heart attacks and premature cardiac death than those who do not. As it is known that estrogen protects blood vessels and protects against hardening of the arteries, it is probable that hormone supplementation will prevent the development or progression of coronary heart disease in most women. However, at the time of this writing, no large independent study has confirmed the benefit of estrogen in this regard; several very large studies are ongoing and their findings should be available in the near future. Until then, the decision of whether or not to take estrogen will be arrived at after a thorough discussion between a woman and her doctor. Important considerations in making this decision are the knowledge that estrogen alleviates some of the symptoms of menopause, such as hot flushes, and retards the development of osteoporosis, or "softening of the bones." The risks of hormone replacement are of developing cancer of the lining of the uterus, the endometrium, and possibly of developing breast cancer. It is important to note that the lifetime risk of coronary heart disease is far higher than the lifetime risk of breast cancer, even if hormone therapy does increase the risk of cancer somewhat. Because of these complex competing risks, the decision as to whether or not to take estrogen should not be made lightly.
Many rehabilitation programs, at least until recently, have focused on exercise and not emphasized the social and emotional impact of heart disease. Perhaps as a result, fewer women than men have participated in these programs. Since the needs of women patients are often somewhat different from those of men, they can benefit from one of the specialized women's programs recently started for women with heart disease. These programs are particularly recommended for those women who do not find traditional cardiac rehabilitation programs practical or accessible.