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  • Title: [Differences and similarities in ischemic heart disease in men and women].
    Author: Piwowarska W, Zylińska M.
    Journal: Folia Med Cracov; 1991; 32(1-2):43-56. PubMed ID: 1843699.
    Abstract:
    Ischemic heart disease (IHD) with its most developed manifestation in the form of myocardial infarction (MI) shows certain differences in the clinical picture between men and women. Pathogenetic differences in the development of IHD between both sexes, protective effects of estrogens, genetic factors and physiology of the sex cycle in women were analyzed. Clinical significance of the selected coronary risk factors including the role of oral contraceptive agents, nicotine, arterial hypertension and professional work were discussed. We made an attempt at specifying reasons for the observed differences and determinants of an increase in morbidity due to IHD in women. The validity of present recommendations for women with the risk for the development of IHD and MI was evaluated. The clinical manifestations of ischemic heart disease (IHD) and myocardial infarction (MI) show certain differences in men and women. The clinical significance of coronary risk factors, including oral contraceptives (OCs), nicotine, arterial hypertension, and stress, were discussed. Smoking increases the risk of IHD more in women than men, especially in young women, those taking OCs, and those with hypercholesterolemia. Smoking also increases the risk of death in the event of myocardial infarction, reduces the age of menopause, detrimentally influences the contractile function of the left ventricle, and reduces the level of the high density lipoprotein (HDL). Alcohol in combination with OCs significantly increases the risk of myocardial infarction through the coagulation mechanism. According to investigations carried out in Goteborg, Sweden, involving women aged 50-59 during 1970-84, the risk of myocardial infarction rises significantly in this age group. Data from 1983-87 in Hungary indicated that the a average incidence of myocardial infarction in women was 14.5/10,000 vs. 35.5/10,000 in men. Investigations within the NORA program during 1970-80 in a population of 46,000 Swedish women showed that the mortality attributed to ischemic heart disease was one fifth that of men of the same age. In summary, lipid disorders in women are a key factor in pathogenesis similar to men; and estrogens exert a beneficial effect on the metabolism of lipids and provide a protective effect to women against ischemic heart disease. On the other hand, stress, the diminished role and value of motherhood, the changed value system, smoking, alcohol abuse, widespread use of OCs, and cumulative genetic factors are involved in the rising rate of ischemic heart disease. The reasons for the observed differences were not specified, neither were the determinants of an increase in morbidity owing to IHD in women. The validity of present recommendations for women at risk of developing IHD and MI was evaluated.
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