Cardiovascular health and disease in women

Each year approximately 2.5 million U.S. women are hospitalized for cardiovascular illness, which also claims the lives of 500,000 women annually; half these deaths are due to coronary heart disease1. Despite the magnitude of this problem and its adverse repercussions on the national public health, we have insufficient information about preventive strategies, diagnostic testing, responses to medical and surgical therapies, and other aspects of cardiovascular illness in women. This lack of information is compounded by the less frequent participation of women in research studies; the difference has been due in part to the exclusion of women of childbearing age and in part to the exclusion of elderly women because of their frequent coexisting illnesses2-4. Characteristics of patients and physicians that limit the participation of women in clinical trials and sex-specific psychosocial or economic factors remain largely unexplored. There is increasing evidence that women undergo intensive or invasive evaluations and treatments for cardiac diseases substantially less frequently than do men with symptoms of similar or lesser severity; this is particularly true for the evaluation of chest pain5-7. The contributions to the differences in the use of procedures of physicians' attitudes toward women patients and their symptoms, different choices made by women themselves, and cultural or social attitudes about sex differences must be assessed, but of pivotal importance is the relation between the use of procedures for women and the clinical outcomes of cardiovascular illness. In January 1992, the National Heart, Lung, and Blood Institute convened an invitational conference, “Cardiovascular Health and Disease in Women,” to highlight new information derived from epidemiologic and clinical research that was appropriate for clinical application and that required wider dissemination and to identify gaps in contemporary knowledge that impeded the delivery of optimal cardiovascular care to women8. In addition to addressing general issues of the cardiovascular health of women, this article summarizes the recommendations of the conference.