CORONARY-ARTERY DISEASE IN WOMEN

Although most women cite breast and reproductive cancers as the diseas es they most fear, in fact cardiovascular disease is much more likely to kill them: 500,000 American women die each year of diseases of the heart and blood vessels compared with 189,000 who die of all cancers c ombined. Women's focus on breast, uterine, and ovarian cancer is very much socially and culturally determined. It reflects an outmoded image of women as valuable principally by virtue of their ability to bear a nd raise children. While women died at about the age of 48 at the turn of the century, biomedical science has extended their life span to th e point that a girl born today has an average life expectancy of 86 ye ars. The focus of recent biomedical investigation reflects the changin g experience and expectations of women, who will. live a full third of their Lives beyond the period of reproductive viability. Since 1988, a flood of new information established that the epidemiology, risk fac tors, clinical. features, outcome and therapeutic choices physicians m ake for female patients with cardiovascular disease are significantly different from those of men. Regrettably, most of the new information we have acquired was almost exclusively harvested from data on Caucasi an women: black women often are less than 10% of study populations. Th e information we do have, however, shows striking differences between women of different races in the severity and outcome of diseases of th e heart and blood vessels: black women have significantly higher morta lity rates from stroke and myocardial infarction than do white women. Intensive research has achieved gratifying corrections in the promptne ss with which physicians diagnose women with cardiovascular disease an d in the aggressiveness of the therapy they offer to female patients. The result has been a reversal of the trend for women to have worse ou tcomes from revascularization procedures than men.