John Holmes, MD
Virginia Mason Medical Center (Seattle, WA)

Coronary artery disease has been widely considered a “man’s disease” and not a major concern for women. Yet cardiovascular disease is the leading cause of death in adult women in the United States. It is also a leading cause of disability among women. Women’s age-adjusted mortality rates from coronary artery disease are four to five times higher than their mortality rates from breast cancer.

Coronary artery disease is caused by the gradual buildup of plaque (made of fat, cholesterol and other substances) on the inside wall of the coronary arteries, which supply oxygen-rich blood to the heart. Over time, the plaque deposits grow large enough to narrow the arteries inside channel, decreasing blood flow to the heart muscle. If the plaque becomes unstable and ruptures, a blood clot can form at the rupture site and block blood flow altogether, resulting in a heart attack.

The risk factors for developing coronary artery disease in women are the same as in men; they are elevated blood cholesterol, high blood pressure, smoking cigarettes, diabetes mellitus, obesity, physical inactivity and a family history of coronary heart disease at a young age. In many coronary artery patients, central obesity, hypertension, impaired glucose metabolism and hyperlipidemia are clustered is what has become known as the “metabolic syndrome”.


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