Coronary artery disease in women

THE TRANSITIONING of human societies from the agrarian societies of prehistoric times to the comparatively more affluent and sedentary contemporary lifestyle has been accompanied by the emergence of chronic lifestyle diseases such as diabetes, hypertension, obesity and dyslipidaemia (high cholesterol).

Through a variety of mechanisms, these risk factors accelerate the deposition of fat and cholesterol within the walls of the arteries of the body (a process called atherosclerosis). Initially, these deposits are so small that they do not significantly impact blood flow through the vessel. However, if unrestrained, the process results in progressive narrowing of the vessel, which ultimately restricts blood flow to the tissue or organ it supplies, thus starving the affected tissue or organ of oxygen and nutrients.

When this occurs in the coronary arteries (the small blood vessels that supply blood to heart muscle), it is called coronary artery disease. Coronary artery disease is the most common form of cardiovascular disease and is characterised by the occurrence of a particular type of chest pain called angina. It may also be complicated by the development of a heart attack (death of heart muscle), heart failure (due primarily to weakness of the heart muscle) or rhythm disturbances (including cardiac arrest).

However, there are important differences in the statistical and clinical features and the investigation and management of coronary artery disease in women relative to men.

STATISTICAL DATA

Women have a lower prevalence (frequency) of coronary artery disease than men. This increases from two women out of every 100 women in the 45-54 age group to 10 out of every 100 in the over-75 age group. This gender difference is thought to be due to the presence of oestrogen in women, which slows the rate of atherosclerosis (relative to the rate at which it develops in men). However, after menopause, the sharp decline in oestrogen levels in women is accompanied by a sharp increase in the rate of atherosclerosis. Women, therefore, generally develop coronary artery disease chronologically 10 years later than men do.

Despite the emergence of coronary artery disease at a later age in women, Jamaica’s peculiar demographic profile (particularly the high percentage of single-parent homes headed by women) means that the occurrence of this condition in women often has a disproportionately more devastating socio-economic and emotional impact on children, families and the wider community.

SYMPTOMS

As is the case with men, the most common symptom in women is angina (pressing, crushing or squeezing central or left-sided chest pain that is worsened by exercise and relieved by rest or nitrates). However, a greater proportion of women than men develop unusual symptoms such as shortness of breath,