Sea differences in the epidemiology and outcomes of heart disease: population-based trends

We examined trends in heart disease (HD) mortality and the delivery of card iac in Olmsted County, MN. Between 1979 and 1994, women experienced 51% of the total number of HD (ICD9 codes 390-398,402,404-429) deaths (3095). Age- adjusted HD mortality rate declined from 123 per 100,000 (95%CI 102, 144) i n 1979 to 81 (67,95) in 1993. The risk ratio (RR) of HD death in 1994 compa red to 1979 was 0.69 for women vs 0.53 for men (P = 0.06). This equates to a decline in HD mortality of 2.5%/y in women and 4.2%/y in men. The decline in HD mortality was less pronounced in older age groups (P < 0.001), refle cting a shift of the burden of HD towards women and the elderly. Compared t o men, there was less use of stress tests among women, of cardiology visits after stress testing, and of cardiac procedures among women presenting to the emergency room with unstable angina. Further studies are needed to exam ine causal links between these trends.