CARDIOVASCULAR DISEASE IN POSTMENOPAUSAL WOMEN VS. MEN : DIFFERENCES - - PowerPoint PPT Presentation

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

34 % 34 % 15 % 15 % 51 % 51 %

Non fatal Non fatal and and fatal fatal myocardial infarction myocardial infarction* * in in men men (35 (35-

• 74

74 years years) MONICA ) MONICA-

• BELLUX

BELLUX

Fatal, out of Fatal, out of hospital hospital Fatal, in Fatal, in hospital hospital Non fatal (NF1) Non fatal (NF1)

* * first events first events, 85 , 85-

• 03

03

35 % 35 % 20 % 20 % 45 % 45 %

Non fatal Non fatal and and fatal fatal myocardial infarction myocardial infarction* * in in women women (35 (35-

• 74

74 years years) MONICA ) MONICA-

• BELLUX

BELLUX

Fatal, out of Fatal, out of hospital hospital Fatal, in Fatal, in hospital hospital Non fatal (NF1) Non fatal (NF1)

* * 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