Types Forms Of Disease Coronary Artery Disease Biology Essay

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Coronary artery disease - also known as coronary heart disease - is a disease in which plaque builds up within the coronary arteries, which supply oxygen-saturated blood to the heart muscle. When plaque builds up within the arteries, the condition is termed atherosclerosis. Plaque build-up occurs over the course of many years. As time passes, the plaque can harden or break open. Hardened plaque narrows the arteries and reduces the flow of oxygen-saturated blood to the heart. Should plaque rupture, a blood clot may form on its surface, which can partially or even mostly block blood that is flowing through the coronary artery. A heart attack occurs when the flow of oxygen-saturated blood to a section of the heart is cut off. When blood flow isn't restored, that section of the heart muscle dies. Heart attacks require quick treatment, as they can lead to other health problems or death.

Over time, coronary heart disease serves to weaken the heart muscle, which can lead to arrhythmias - issues with the rate or rhythm of the heart beat - or heart failure - a condition in which the heart is unable to pump enough blood to meet the body's needs.

Coronary heart disease is the most prevalent type of heart disease. In the U.S., coronary heart disease is the number one cause of death for both men and women.

Other names for coronary heart disease are atherosclerosis, coronary artery disease, ischemic heart disease, and hardening or narrowing of the arteries.

Causes of Coronary Artery Disease

Certain factors can contribute to damaging the inner layers of the coronary arteries and increase risk. Included in these factors is [101]:


Elevated cholesterol levels

High blood pressure

Elevated levels of sugar in the blood as a result of insulin resistance or diabetes mellitus

Inflammation of blood vessels

When the arteries are damaged, plaque might build up. This process can start as early as childhood. In addition to the above factors, blood clots that result from ruptured plaque may further narrow the arteries, prompting angina or causing a heart attack.

Risks, Signs, and Symptoms

Coronary artery disease occurs when plaque builds up in the coronary artery disease. Coronary artery disease customarily presents as angina, or in severe cases, as a heart attack, when one of the coronary arteries becomes blocked.

There are a number of major risk factors for development of coronary artery disease [101], most of which can be controlled or prevented through making healthy lifestyle choices. These risk factors include:

Blood cholesterol levels that are unhealthy. This can happen when LDL cholesterol is high or HDL cholesterol is low.

High blood pressure, which in healthy individuals is blood pressure that is at or above 140/90mmHg. In individuals who have diabetes or kidney disease, this is blood pressure that is at or above 130/80 mmHg.

Smoking. Smoking damages and tightens blood vessels, which in turn can lead to unhealthy levels of cholesterol as well as high blood pressure. Smoking also limits how much oxygen gets to the body's tissues.

Insulin resistance, a condition that occurs when the body is unable to use its own insult properly. This condition may in turn lead to diabetes.

Diabetes mellitus

Obesity - to determine obesity body mass index (BMI) may be utilized. Obesity is generally defined as having a BMI of 30 or greater [Snowden - online]. Having a high BMI is linked with a greater risk of sudden death, regardless of if the individual smokes or has another serious illness.

Metabolic syndrome, which can increase the risk of not only coronary heart disease but also contributes to the development of other health problems, such as diabetes or stroke.

Lack of physical activity. This can worsen other coronary heart disease risk factors, including unhealthy cholesterol levels, unhealthy blood pressure, diabetes, and obesity.

An unhealthy diet, including foods high in saturated fats and trans fats, cholesterol, salt and sugar, may worsen other coronary heart disease risk factors.

Age. Older age means that there has been more time for plaque to build in the arteries, leading to signs and symptoms of coronary artery disease. The risk for men for coronary heart disease increases beyond age 45. The risk for women increases beyond age 55.

Family history. There is an increased risk if the individual's father or brother was diagnosed with coronary heart disease before age 55, or if the individual's mother or sister was diagnosed with coronary heart disease before age 65.

Sleep apnea, if left untreated. Sleep apnea may serve to increase the risk of high blood pressure, diabetes, stroke, or heart attack.

Stress. Stress that occurs in the body as a result of strong emotions, such as anger, can prompt cardiovascular events.

Excessive alcohol consumption. Consuming alcohol in excess can damage the heart as well as worsen other coronary heart disease risk factors. There are different guidelines for men and women regarding how much alcohol is an optimal amount. Women should limit their alcohol intake to one drink per day, while men are permitted two drinks per day.

Preeclampsia, a condition which sometimes occurs during pregnancy. The condition is linked to an increased risk in the development of coronary heart disease as well as increased risk of high blood pressure, heart attack, and heart failure.

Even with risk factors such as older age and family history, there is no guarantee that an individual will develop coronary heart disease. Living a healthy life serves to lessen the influence age and genetics has on the development of coronary heart disease.

There are additional emerging risk factors [101], such as having high levels of C-reactive protein - a sign of inflammation - in the blood. Inflammation occurs in response to injury or infection. When the arteries' interior walls are damaged, this may trigger inflammation. Additionally, high levels of triglycerides may raise the risk of coronary heart disease, particularly in women.

Signs and symptoms of coronary heart disease are:

Angina, which occurs when an area of the heart doesn't get enough oxygen-saturated blood.

Shortness of breath. This symptom is present when coronary heart disease causes heart failure.

No symptoms - it is possible to have coronary heart disease without having any symptoms. When this occurs the disease may go undiagnosed until a severe cardiovascular event occurs.

Related problems include:

Heart attack. Heart attacks occur when the flow of oxygen-saturated blood to a section of the heart is cut off. This frequently occurs when an area of plaque breaks open. Signs and symptoms of a heart attack include:

Discomfort in one arm, the back, neck or jaw, or upper area of the stomach

Shortness of breath

Nausea, lightheadedness or fainting, or perspiring in a cold sweat

Sleep disturbances, fatigue, low energy

Heart failure is a condition in which the heart is unable to pump enough blood to meet the body's needs. Common signs and symptoms of heart failure, which are a result of fluid buildup in the body, include:

Shortness of breath


Swelling in the ankles, legs, stomach, or veins of the neck

Arrhythmia, a problem in which the rate or rhythm of the heart is disturbed. Signs and symptoms of arrhythmia include:

Most commonly, heart palpitations

Sudden cardiac arrest may be caused by a problem with arrhythmia.

Hypertensive heart disease

What is hypertensive heart disease?

Hypertensive heart disease [102] is a problem that occurs in the heart as a result of high blood pressure. Hypertensive heart disease is a contributing factor in coronary artery disease, heart failure, and the thickening of the heart muscle.

Hypertensive heart disease is the number one cause of illness and death resulting from high blood pressure [102].

Causes of hypertensive heart disease

When an individual has high blood pressure, there is an increase in the pressure in blood vessels. When the heart is pumping against this increased pressure, the heart must work harder than it would have under normal blood pressure conditions. This increased work load causes the heart muscle to thicken over time. Additionally, high blood pressure can cause the walls of blood vessels to thicken as well, which leads to further related problems.

Risks, Signs and Symptoms

One of the biggest risks to the development of hypertensive heart disease is lifestyle. These risks include [102]:

The development of diabetes mellitus

Obesity - Obesity is usually linked with higher cholesterol and blood pressure and places a burden on the heart muscle

Lack of physical activity. Lack of physical activity can lead to unhealthy blood pressure and can worsen other coronary heart disease risk factors, including unhealthy cholesterol levels, diabetes, and obesity.

An unhealthy diet, including foods high in saturated fats and trans fats, cholesterol, salt and sugar, may heighten blood pressure.

Family history. A family history of heightened blood pressure is not a guarantee that an individual will experience high blood pressure; healthy lifestyle choices can help combat a family history of high blood pressure and hypertensive heart disease.

Stress. Stress that occurs in the body as a result of strong emotions, such as anger, can prompt blood pressure to reach unhealthy levels and put strain on the heart muscle.

Excessive alcohol consumption. Consuming alcohol in excess can damage the heart as well as worsen other coronary heart disease risk factors. There are different guidelines for men and women regarding how much alcohol is an optimal amount. Women should limit their alcohol intake to one drink per day, while men are permitted two drinks per day.

Signs and symptoms of hypertensive heart disease are:

Shortness of breath


Low energy

Related problems include:

Congestive heart failure. If left untreated, hypertensive heart disease can lead to congestive heart failure.

Coronary artery disease. High blood pressure is a cause of coronary artery disease due to the fact that thickened heart muscle needs more oxygen than does normal heart muscle.

Atherosclerosis may worsen as a result of the thickened blood vessel walls. This increases the risk of stroke or heart attack.


What is cardiomyopathy?

Cardiomyopathy refers to a weakening of the heart muscle or other structural change to the heart muscle. This condition frequently occurs when the heart has difficulty pumping, or may occur with other problems related to heart function. Many patients who have cardiomyopathy also have heart failure.

There are several common types of cardiomyopathy [103]. These include:

Dilated cardiomyopathy, a condition where the heart becomes weakened and enlarged. This means that the heart cannot pump blood as well.

This can also lead to damage of other organs in the body, such as the liver.

Dilated cardiomyopathy is the most common form of cardiomyopathy.

Hypertrophic cardiomyopathy, a condition where the heart muscle thickens. This makes it more difficult for blood to exit the heart, causing the heart muscle to work harder.

This type of cardiomyopathy is frequently asymmetrical, with one part of the heart being thicker than are other parts.

This type of cardiomyopathy is usually inherited, and the may be the result of a number of problems with genes controlling heart muscle growth.

The condition is more likely to be more severe in younger people, but individuals of all ages can develop this type of cardiomyopathy.

Hypertrophic cardiomyopathy is also known as idiopathic hertrophic subaortic stenosis, asymmetric septal hypertrophy, or hypertrophic obstructive cardiomyopathy.

Ischemic cardiomyopathy, a condition that is caused when the arteries that supply blood to the heart become narrow. This condition is a result of coronary artery disease.

Narrowing of arteries frequently results from the buildup of plaque in the arteries.

Patients with ischemic cardiomyopathy frequently have heart failure.

Patients who have this condition frequently also have a history of angina or heart attacks.

Ischemic cardiomyopathy is the most common form of cardiomyopathy in the U.S., and affects middle aged and the elderly most often.

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Restrictive cardiomyopathy, which is a grouping of disorders where the chambers of the heart cannot fill with blood properly as a result of the heart muscle becoming stiff.

The heart will be a normal size of slightly enlarged. However, the heart will be unable to relax normally in the time between heartbeats.

In advanced stages of this type of cardiomyopathy, the heart may not be able to pump blood very efficiently. This can affect other organs in the body, such as the lungs and liver

This kind of cardiomyopathy occurs quite frequently post heart transplant.

There are several specific causes of this type of cardiomyopathy. The most common are amyloidosis and idiopathic myocardial fibrosis. Others include:

Carcinoid heart disease

Overload of iron in the system, also known as hemochromatosis


Tumors in the heart


Certain diseases that affect the heart lining, including endomyocardial fibrosis or Loeffler's syndrome.

Restrictive cardiomyopathy is also known as infiltrative cardiomyopathy.

Peripartum cardiomyopathy, a condition that occurs during a pregnancy or within the first 5 months following a pregnancy. Peripartum cardiomyopathy is very rare.

This is a form of dilated cardiomyopathy; in this form no cause of why the heart is weakened is able to be identified.

Peripartum cardiomyopathy is a complicated condition and complicates one out of every 1300 - 4000 deliveries in the U.S.

This cardiomyopathy is most common in women who are older than 30.

There are several risk factors for developing this form of cardiomyopathy, which include:


A history of certain cardiac disorders, for example, myocarditis

Certain medication


Excessive use of alcohol

Race, particularly if the individual is African American

Malnourishment during pregnancy

Causes of cardiomyopathy

Causes of cardiomyopathy vary dependent on the type of cardiomyopathy. However, there are a number of general common causes of cardiomyopathy [103]. These are:

Excessive use of alcohol or cocaine


The effects of drugs used for chemotherapy. Drugs used for chemotherapy, and some other drugs, are toxic to the heart.

Coronary heart disease, which is the most common cause of cardiomyopathy

End stage kidney disease


Hypertension, particularly when it is poorly controlled.

Infections that result from viruses such as HIV, Chagas disease, or Lyme disease

Deficiencies in nutrition, particularly deficits in selenium, thiamine, calcium, or magnesium.


Certain autoimmune disorders that also involve the heart, for example, systemic lupus erythematosus or rheumatoid arthritis.

Certain heart rhythm problems such as atrial fibrillation or supraventricular tachycardia.

Some trace elements, including mercury, arsenic, and lead.

Risks, signs, and symptoms

The risk factors, signs, and symptoms vary according to what form of cardiomyopathy the individual has.Top of Form

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Valve disorders/Other heart diseases

What are heart valve disorders?

Heart valve disease is a disease that occurs when one or more of the four heart valves doesn't work as it should. The valves have flaps of tissue that open and close with every heartbeat. These flaps make certain that the individual's blood flows in the correct direction through the heart's chambers as well as to the rest of the body.

There are three basic problems that heart valves can have [104]:

Regurgitation, which occurs when a valve fails to close tightly. This is also known as backflow because blood leaks back into the heart's chambers as opposed to flowing forward throughout the heart or to an artery.

In the U.S., regurgitation is most often due to prolapse, which occurs when the flaps of the valve bulge or flop back into one of the upper heart chambers during a heartbeat. Prolapse almost always affects the mitral valve.

Stenosis, which occurs when the flaps of a valve thicken, become more stiff, or even fuse together. This action prevents the valve from opening fully. As a consequence, there is not enough blood flowing through the valve.

Atresia, which occurs when a heart valve does not have an opening for blood to go through.

Causes of heart valve disease

There are a number of factors that can contribute to heart valve disease. These include:

Birth defects. This is congenital heart valve disease, with the primary cause being genetics. Other causes are unknown, as congenital heart valve disease occurs when the heart is still being formed.

Certain other heart conditions, which can contribute to acquired heart valve disorders. These conditions include:

Damage or scar tissue that is the result of injury to the heart, such as a heart attack.

High blood pressure that is very advanced

Heart failure

Atherosclerosis that occurs in the aorta

Age related changes to the heart, which can contribute to acquired heart valve disorders.

Men who are more than 65 years of age and women who are more than 75 years of age are more prone to the development of calcium or other deposits within the heart valves. The deposits serve to stiffen or thicken the flaps of the valve, which limits blood flow.

In particular, the aortic valve is especially likely to have this problem.

Rheumatic fever, which can contribute to acquired heart valve disorders. Rheumatic fever that is the consequence of untreated strep infections that progress may cause heart valve disease.

As the body works to fight the infection, heart valves may become damaged or scarred.

The valves that are affected most often are the aortic and mitral valve.

Symptoms of the damage frequently aren't evident for a number of years following the rheumatic fever

This is less common in current times, since the majority of people with strep infections are treated with antibiotic medication well before the infection progresses into rheumatic fever.

Heart valve disease primarily affects older adults who contracted strep infections prior to the availability of antibiotics or people in developing nations where there is a higher incidence of rheumatic fever.

Certain infections, which can contribute to acquired heart valve disorders

Sometimes when germs enter the bloodstream and get carried to the heart they end up infecting the inner areas of the heart, including heart valves. This kind of infection is rare but very serious and is termed infective endocarditis.

Germs have the ability to enter the bloodstream through certain medical devices, needles, syringes, and cracks in the skin or gums. Frequently, the immune system fights the germs and there is no resulting infection. However, in some cases the immune system fails to effectively fight the germs; the result is infective endocarditis.

People who already have a history of abnormal blood flow in the heart resulting from heart valve disease are at higher risk for developing infective endocarditis. This is because the abnormal blood flow results in blood clots forming on the valve's surface, which in turn make it simpler for germs to attach to the valve and cause an infection.

Existing heart valve disorders can be worsened by infective endocarditis.

When any of these things causes one of more of the heart valves to not open as it should, changes the shape or flexibility of the valves, or permits blood leakage back into the chambers of the heart, the individual's heart has to work harder. This affects the heart's ability to pump blood.

There are a number of other factors and conditions that are linked to heart valve disorders [104], although what their causal role is is unclear. These include:

Certain autoimmune disorders, including lupus. Lupus may affect the aortic or mitral valve.

Carcinoid syndrome. When tumors spread to the liver or to the lymph nodes, they may affect the tricuspid or pulmonary valve.

Metabolic disorders, including the somewhat rare Fabry disease as well as more common disorders such as high cholesterol, may impact heart valves.

Certain diet medications, in particular fenfluramine and phentermine, are linked to heart problems.

Radiation therapy, when administered to the chest area.

Marfan syndrome, a congenital disorder that can affect heart valves.

Risks, signs, and symptoms

Some individuals are born with a heart valve disorder (congenital). However, it is possible to develop heart valve disease later in life as well.

Congenital heart valve disorders:

Genetics is the primary risk factor for congenital heart valve disorders.

The disease may occur alone or it can occur along with other congenital heart defects.

Congenital heart valve disorders frequently involve the pulmonary or aortic valve in such a way that these valves fail to form properly. For example, the valves may not possess enough tissue flaps, be the incorrect size or shape, or not have an opening for the blood to flow through properly.

Heart valve disease that has been acquired typically involves the aortic or mitral valve. The valve may be normal at birth, but problems then develop over time.

Those at greatest risk for developing heart valve disease include:

Those who are older, since with aging the heart valves thicken and stiffen.

Individuals who have a history of infective endocarditis, heart failure, rheumatic fever, heart attack, or a previous heart valve disorder.

Individuals who are at risk for developing coronary heart disease. Some of these risk factors are: family history, obesity, low physical activity, diabetes or insulin resistance, smoking, high blood pressure, and high cholesterol.

Individuals born with a bicuspid aortic valve.

Both of these forms of heart valve disease may cause stenosis or regurgitation.

Many people with heart valve disorders do not have symptoms. It is not uncommon for some people to never show any symptoms. However, those who do may experience disturbed heart rate, such as a heart murmur, as well as complicating factors listed below. If left untreated heart valve disorders, particularly in their advanced stages, may cause:

Heart failure


Blood clots

Sudden cardiac arrest

Since heart valve disease frequently worsens over time, an individual may show no signs or symptoms when the heart murmur is first detected. It is common for may who have heart valve disorders to lack symptoms until they are older.

Other signs and symptoms are related to heart failure, a condition that heart valve disease may cause. These include:

Extreme fatigue

Shortness of breath, particularly when the individual exerts him or herself or while lying down.

Swelling in the feet, ankles, legs, abdominal area, or in the veins in the neck.

It is not infrequent for individuals to only notice a problem when they exert themselves. This may manifest as a fluttering or racing heartbeat, or an irregular heartbeat.

There are currently no medications available to cure heart valve disease. However, the symptoms as well as the complications of heart valve disease may be eased by making lifestyle changes or utilizing medication to treat the complications.


Diagnostic Tests

There are a variety of diagnostic methods utilized to diagnose cardiovascular problems in women. These tests vary depending on the type of suspected condition, and include [105]:

Physical Exam and gathering of family history. This is a first step toward diagnosing cardiovascular disease.

Blood tests. Drawing blood allows for the diagnosis of cardiovascular disease through the presence of certain substances. For instance, practitioners may check cholesterol, triglycerides, or blood cell count.

Chest X-Ray. This test reveals an image of the heart, lungs, and blood vessels, and can indicate if the heart is enlarged. This test is important because enlargement of the heart can indicate certain types of cardiovascular problems.

Holter monitoring. This portable device is worn by the individual to record a constant ECG. The device is generally working for 24 - 72 hours and can be used to detect irregularities in heart rhythm that aren't showing up during a standard ECG exam.

Cardiac catheterization. This test can measure the blood pressure in the heart's chambers.

Heart biopsy, wherein a small sample of the individual's heart tissue is removed via catheterization and sent to a lab to be tested.

ECG exercise test [1]. This test is lower in sensitivity and specificity [106] when used for women. This is in part related to the smaller extent of cardiovascular disease in women as well as the higher prevalence of conditions such as mitral valve prolapse and hormonal influence. Additional factors that contribute to lower diagnostic accuracy in this test when used for women are that women experience chest pain that is atypical and commonly do not reach the target heart rate [107-109]. The latter may be a result of reduced exercise capacity in women, primarily stemming from conditions such as obesity or osteoarthritis. The test, however, is recommended for women who are able to exercise and possess a low to intermediate probability of cardiovascular disease. The American Heart Association has in fact recommended that this test be utilized for these low to medium risk women, provided that there are no contraindications to the testing [110]. Since sex has an apparent impact on the accuracy of this test, practitioners should keep in mind the differences in testing when utilizing this test as a diagnostic tool as well as in interpreting results. The mechanisms that contribute to sex differences are unclear; however, they may be related in particular to differential aspects of estrogen on the ST segment [111,112], as well as differences in vascular reactivity [110]. Utilizing imaging, as opposed to non-imaging, stress testing may help in identifying vascular flow obstruction.

Stress echocardiography. This test allows for more accurate information on both systolic and diastolic function as well as on valvular diseases and myocardial ischemia. In one test of more than 1000 women who had suspected coronary artery disease, this test had a sensitivity that ranged from 81-89%, with a specificity of approximately 86% [113]. This testing method may be limited by conditions such as obesity and certain pulmonary function.

Gated single-photon emission computed tomography (SPECT) can help detect flow reserve patterns [114-116] and may help predict cardiac death as well as myocardial infarction [117,118]. SPECT is a nuclear technique that allows for visualization of how the ventricles are functioning as well as regional or global perfusion defects. Research findings indicate that SPECT may be more specific than exercise electrocardiography as well as perhaps being considered a more effective approach to diagnosing cardiovascular diseases such as coronary artery disease in women [119]. However, there are some limitations when used for detecting cardiovascular disease in women; SPECT can have false positives, primarily because the heart is smaller in women. The tissue of the breast may also produce false positives [113,120]

Cardiovascular Magnetic Resonance Imaging may serve to provide a different method for evaluating subendocardial ischemia, higher precision for assessing the function of the left ventricle, and a thorough anatomic evaluation of the myocardium and peripheral vasculature. This test also has the ability to detect adjustments in myocardial metabolism. The cardiovascular magnetic resonance imaging test has advantages specific to its use for women, including excellent characterization and contrast of soft tissue, three-dimensionality, total quantification of blood flow, and better overall temporal and spatial resolution when imaging vascular and myocardial abnormalities [121-123]. There are however, also some constraints to using this test, including the fact that it is expensive as well as the fact that it may cause claustrophobia in some individuals.

Coronary Computed Tomography. This test serves to evaluate and quantify the level of calcium in the coronary arteries [124]. Calcium levels serve as an early marker of cardiovascular disease. The coronary artery calcium score (CACS) is recognized as an independent and incremental forecaster for cardiovascular events in patients who have an intermediate risk of cardiovascular disease [125, 126] as well as both short and long term events. One study indicated that women who had a high calcium score had a high mortality rate at 5 years [127]. While there is not much data on calcium scores as a risk factor for women who do not have symptoms, it can be considered a risk factor and a marker in women who have intermediate risk of developing coronary artery disease. Given this, computed tomography should be utilized in women who have an intermediate risk of developing coronary heart disease, as selective use of coronary calcium scores may be appropriate in these patients [126]. CACS screening is equally accurate in both men and women. Relative risk of a cardiovascular event increases in proportion to coronary calcium levels [128]. In one recent study of 1126 asymptomatic patients, of which 30% were women, it was displayed that a severe CACS indicates individuals who were at a high long-term cardiovascular risk, even when tests such as SPECT were normal. The researchers concluded that in individuals who are at an intermediate or high risk of cardiovascular disease, the use of CACS could help better indicate those individuals who will have a high long term risk of adverse cardiovascular events [129].

Multi-Slice Computed Tomography (MSCT). This test is a quickly evolving imaging technique as well as a potential alternative to the non-invasive tests for cardiovascular disease that already exist. While diagnostic accuracy in women has not specifically been investigated, results extrapolated from male data indicate that this is a promising technique for use in women. The 64 slice computed tomography possesses a high sensitivity for detecting substantial coronary stenosis, and is reliable for ruling out the presence of significant cardiovascular disease [130]. The sensitivity was very good for detecting substantial coronary heart disease, in both men and women. One study indicated that predictive parameters were lower for women, primarily because women have smaller blood vessels than do men [131]. Therefore, further research is necessary to effectively validate this testing method for women.


There has been intensive research and debate over possible disparities between the sexes in regards to treatment. Cardiovascular disease affects men and women differently, and it affects them at different times in their lives [4]. Treatments for cardiovascular disease vary as well and affect men and women differently. One or more of the following may be necessary to treat the individual's specific cardiovascular problems: medication, changes to lifestyle, or surgery or other procedures.

There is also a difference in the level of treatment women receive. The Cooperative Cardiovascular Project [132] indicated that women received less treatment after myocardial infarction and received fewer aspirin prescriptions upon discharge. However, women were 5% more likely than were men to receive ACE inhibitors. There are those in the medical community that may argue that fewer women receive evidenced-based therapies because women in general have a lower likelihood to have significant coronary disease.

It is important to remember that men and women respond in different ways to medication. For instance, women generally take more medications than do men [133]. Women also respond differently to medication, primarily because they differ from men in physiology pharmacodynamics and pharmacokinetics [134-136]. Further, women have a higher likelihood than do men to have injuries related to their medication, i.e., adverse drug effects [137,138]. However, women have often been underrepresented in drug studies [139,140] and there is still much that needs to be learned regarding the safe, effective and optimal use of medication in women.

Cardiovascular Disease Treatments:


Aspirin therapy is the most popular choice for prevention of cardiovascular disease, and has been well established as being an effective treatment for men. A meta-analysis of six individual studies, with a total of 53,035 patients - 11,466 of which were women - [141] has indicated that aspirin serves to reduce the risk of a first myocardial infarction by 1/3 and reduces the risk of other events by 15%. However, evidence that supports aspirin for primary prevention of coronary heart disease in women is not as strong. In a recent analysis of data gathered from 44,114 men and 51,342 women [142] it was discovered that aspirin therapy, while reducing myocardial infarction in men by 32%, did not significantly reduce the incidence of myocardial infarction in women. Based on this evidence, it is not indicated that women who are younger than 65 years of age utilize aspirin to reduce the risk of a first myocardial infarction [143]. One possible reason for this may be aspirin resistance.

Statins. The role of statins as a drug utilized for primary prevention of coronary heart disease is controversial in women, and indeed, their effectiveness in women is questionable. However, in one recent study [144] that examined the effect of statins on the risk of cardiovascular disease, results indicated that statins were equally effective in prevention in both men and women, and discovered that both men and women experienced a 30% reduction in risk of major cardiovascular events.

Beta blockers. Beta blockers may benefit women more than they do men. In one study, women responded to beta blocker therapy with a reduction in mortality of 31%, compared to a 5% reduction in men [145]. However, several recent trials have indicated that women and men respond equally well to beta blocker therapy [146, 147].

ACE inhibitors. There is growing literature on sex differences in regards to ACE inhibitors; however, there are no studies that specifically address this particular issue. However, the consideration of some previous observations may be prudent. Pooling 30 studies of ACE inhibitors and heart failure, with a total of 1587 women across all studies indicated that there was a substantial decrease in mortality (37%) and hospitalization in men, whereas women only experienced a 22% decrease. A more recent meta analysis confirmed this data [148]. Therefore, ACE inhibitors may indeed affect men and women differently. There are sex differences in pathophysiology that may account for the disparity. For instance, the ACE2 gene has been shown to map to certain loci on the X chromosome [149]. However, the specific role this plays is currently unknown. Additionally, sex differences in lower rates of reactive hypertrophy have been indicated.

Clopidogrel.Clopidigrel may work differently in men and women. In a meta analysis of 5 large studies that included more than 79,000 people, 30% of which were women, Berger et al [150] discovered that clopidogrel was linked with a 16% reduction in occurrence of cardiovascular events in men, as compared with a 7% reduction of cardiovascular events in women. Among the women enrolled in these studies, the risk reduction appeared to be greatest for myocardial infarction, while effects on stroke and sudden death were not statistically significant. It was found that clopidogrel increased the risk of major bleeding by 43% in women, as compared with 22% in men. The difference was not found to be statistically significant, but what was significant about the finding was that it mirrored the differential effects between the sexes often seen with aspirin. Women were shown to be hyporesponsive to clopidogrel much more frequently [151].

Lifestyle changes. Changing one's lifestyle to reflect healthier choices can help treat cardiovascular problems. For instance, exercising regularly can help lower a high resting heart rate, a risk factor for cardiovascular disease. Exercising regularly can also help relieve stress and lower blood pressure, another risk for cardiovascular problems. Other recommended changes are eating healthily, to help lower cholesterol and blood pressure. Quitting smoking also lowers blood pressure and allows the heart to work less hard. Typical recommendations for lifestyle changes include eating a diet that is low in fat and sodium, exercising moderately for at least 30 minutes on most days, not smoking or quitting smoking, and limiting alcohol consumption.

Medical procedures. Medical procedures can include such procedures as a coronary angioplasty or heart bypass surgery.


Aspirin therapy. There is no strong evidence that supports aspirin for primary prevention of coronary heart disease in women. A recent analysis of data indicated that while aspirin therapy reduced myocardial infarction in men by 32%, it did not significantly reduce the incidence of myocardial infarction in women. One possible reason for this may be aspirin resistance. One recent study examined aspirin resistance in order to determine whether those who experience myocardial infarction also have a higher rate of aspirin resistance [152]. The study found that women were 4 times more likely to be aspirin resistant than were men, although why this is the case is still unknown. Typically, aspirin resistance has been blamed on genetic differences in the COX-1 gene, platelet antigen or the glycoprotein IIb/IIIa receptor [153-156]. Whether the resistance is the result of biology or clinical occurrences, routine testing of patients to determine their response to aspirin therapy is not recommended. This is an area that warrants future research into how aspirin therapy may be tailored specifically to each patient, research that would be crucial to the health of women in particular, who are in need of patient-specific therapies.

Statins. The role of statins as a drug utilized for primary prevention of coronary heart disease is controversial in women. Women have typically been underrepresented in clinical trials on statin therapy, leading to two schools of thinking where statins are involved. One side indicates that statins are useful in primary prevention, while the other side indicates that this is an assumption and not supported by evidence [157]. One study conducted by LaRosa et al [144] examined the effect of statins on the risk of cardiovascular disease utilizing data from two primary prevention trials [158,159] and 3 secondary prevention trials [160-162]. The researchers indicated that results showed that statins are equally effective in prevention in both men and women, and discovered that both men and women experienced a 30% reduction in risk of major cardiovascular events.

Beta blockers. Beta blockers may benefit women more than they do men. In one study, women responded to beta blocker therapy with a reduction in mortality of 31%, compared to a 5% reduction in men [145]. However, several recent trials have indicated that women and men respond equally well to beta blocker therapy [146,147].

ACE inhibitors. Effectiveness in women is not well known, as there have been no sex-specific studies done to evaluate the effects in women.

Clopidogrel. Clopidogrel may work differently in men and women. In a meta analysis of 5 large studies that included more than 79,000 people, 30% of which were women, Berger et al [150] discovered that clopidogrel was linked with a 16% reduction in occurrence of cardiovascular events in men, as compared with a 7% reduction of cardiovascular events in women. Among the women enrolled in these studies, the risk reduction appeared to be greatest for myocardial infarction, while effects on stroke and sudden death were not statistically significant. It was found that clopidogrel increased the risk of major bleeding by 43% in women, as compared with 22% in men.

Lifestyle changes can make a marked difference, particularly in those at risk for developing cardiovascular disease. Taking action to lower blood pressure and cholesterol, as well as reach a healthy resting heart rate can help alleviate or even prevent cardiovascular disease.

Side effects

Aspirin therapy. Aspirin therapy is not for everyone. The usage of aspirin therapy depends in great part on the risk factors the individual displays for cardiovascular disease. Risk factors such as smoking, high blood pressure, high cholesterol, lack of exercise, diabetes, stress, excessive alcohol consumption and a family history all must be considered before partaking in aspirin therapy. Aspirin therapy may serve a function in preventing a second myocardial infarction, and it may also be beneficial for those with strong risk factors who have not experienced a myocardial infarction. However, there are some conditions that make aspirin therapy dangerous. These include: bleeding or blood clotting disorder, asthma, a history of stomach ulcers, or heart failure. Aspirin is not recommended for diabetic women who are younger than 60. It is also important to remember that other medications may affect aspirin therapy, or vice versa. For example, when aspirin and ibuprofen are taken together, this reduces aspirin's affect. Also, taking aspirin along with other anticoagulants can markedly increase the chance of bleeding.

Statins. The FDA [163] advises taking care when utilizing statins. Statins have a number of side effects, including liver problems, mental impairment, an increased risk of developing Type II diabetes, and drug interactions that may lead to muscle damage. The FDA reports that liver damage is rare, but patients should still have their liver enzymes routinely monitored. Regarding mental impairment, the FDA has received reports of memory loss; however the memory loss was not serious and generally reversible. With diabetes, there has been a small reported increased risk. The potential is great for muscle damage if certain medications are taken with statins.

Beta blockers. Many people who take beta blockers do not experience any side effects. However, side effects do exist [164]. Common side effects include fatigue, clod hands, headache, upset stomach, constipation or diarrhea, and dizziness. Among the less common side effects are shortness of breath, difficulty sleeping, loss of the sex drive, and depression. Beta blockers also aren't customarily utilized in those individuals with asthma, since concerns have been raised that they may trigger serious asthma attacks. Beta blockers must be used with caution in those patients who are diabetic, since they can block some of the signs of low blood sugar, for example, a rapid heartbeat. Therefore, diabetics must carefully monitor blood sugar if they are using beta blockers.

ACE inhibitors. ACE inhibitors do not have many side effects. However, one common side effect is dizziness [165]. This generally occurs if a too high dose has been administered at the onset of usage. ACE inhibitors may also cause problems with the kidneys or level of potassium, coughing, low blood pressure, or rarely, swelling of the lips or throat.

Clopidogrel. Common side effects with clopidogrel are: chest pain, bruising deeply, itching, pain, or redness, and generalized pain. Less common are side effects such as nosebleed, difficulty or pain in urinating, shortness of breath, and vomiting blood, and rarely some patients experience very dark stools, blistering and peeling skin, blood in their urine, confusion, fever, sudden and very severe headaches, nausea or stomach pain, ulcers of the mouth, and sudden weakness [166].

Lifestyle changes. Many people feel better after changing their lifestyle to reflect healthy choices. Some caution needs to be taken, however. Those with accelerated heart rate (tachycardia), heart arrhythmia, and certain valve disorders must take caution with lifestyle changes such as exercising.

Treatments for Heart Arrhythmia

Dependent on the condition and the seriousness of the condition, practitioners can recommend maneuvers or medication to correct the irregular heartbeat. There is also the possibility of utilizing medical devices or surgery for more serious conditions [167].

Treatments for heart arrhythmia include [167]:

Vagal maneuvers. These maneuvers require that the individual do things such as holding his or her breath while straining, dunking the face in ice water, or coughing. The maneuvers serve to affect the vagal nerves, which controls heart rate. It is important that individuals with arrhythmia be advised to refrain from attempting any maneuvers before having consulted a doctor.

Medication. Medications including anti-arrhythmic mediation may help individuals who are experiencing a rapid heart rate. These may reduce episodes of the heart beating too rapidly or serve to slow the heart down when there is an episode. Individuals must take medication exactly as prescribed to avoid experiencing complications.

Medical Procedures. There are two common procedures utilized to treat arrhythmia. These are cardioversion and ablation. In cardioversion, an electric shock is utilized to reset the individual's heart back to the normal rhythm. In ablation, catheters are threaded through the blood vessels to the inner heart, where electrodes located at the catheter tips destroy a small bit of heart tissue and create a block in the pathway that's causing the arrhythmia.

Pacemaker or implantable cardioverter defibrillator. The pacemaker will deliver electrical pulses to control heartbeat rhythm. The implantable cardioverter defibrillator can correct a heartbeat that is too rapid or is chaotic by using an electric pulse hat is similar to that which is used in cardioversion. Each of these requires surgery, which is minor and typically only needs a few days recovery time.

Surgery. Sometimes sever arrhythmias need surgery. This also may prove necessary for those individuals who have an underlying cause to their arrhythmia, for example, a heart defect. Surgery is considered a last resort because it is open heart and may require months of recovery.


Treatments for heart defects

Dependent on the defect, treatment may or may not be required. Treatments for heart defects include [167]:

Medications. Some mild heart defects, particularly those found later on in childhood or adulthood, may be treatable with medications to help the heart work more efficiently.

Certain procedures using catheters. Some people are now able to have their congenital heart defects repaired utilizing catheterization techniques, which allows the repair to be made without surgically opening the chest.

Surgery. In some cases, it may become necessary for a defect to be repaired utilizing open heart surgery. Surgery is a major procedure and typically require a long recovery time. Individuals who require surgery may need multiple surgeries to treat or repair a severe defect.

Heart transplant. If a defect is serious to the point that it can't be repaired, a heart transplant is one option to consider

Treatments for Cardiomyopathy

Treatments used for cardiomyopathy varies dependent on the type of cardiomyopathy the individual has as well as how serious it is. Treatments for cardiomyopathy include [167]:

Medication. Practitioners can prescribe medications that will improve the heart's ability to pump blood. These medications may include ACE inhibitors, for example, or beta clockers, which help the heart beat less forcibly. These reduce strain on the heart and help it to work more efficiently.

Medical devices. Treatment with medical devices vary with the type of cardiomyopathy the individual has. For example, if he or she has dilated cardiomyopathy, the use of a special pacemaker that works to coordinate the contractions between the right and the left ventricles of the heart may help improve the heart's pumping ability.

Heart transplant. If a cardiomyopathy is severe and medications don't work well to control the symptoms, a heart transplant is an option to consider.

Treatments for Heart infections

Treatment varies by infectious condition, but the first treatment given for infections such as pericarditis, myocarditis, or endocarditis is frequently medication. Frequently administered medication for infections includes [167]:

Antibiotics. If a condition is brought on by bacteria, practitioners may prescribe antibiotics as a course of treatment. These are given via IV for 2 - 6 weeks, dependent upon how serious the infection is.

Medications to regulate the beat of the heart. Sometimes cardiovascular infections affect the heartbeat. If this happens, practitioners may prescribe a medication such as an ACE inhibitor or beta blockers to help work to normalize the heartbeat.

There is also the option of surgery. This is an option if the heart infection is severe to the point that it damages the heart. Surgery may then be needed to repair the damaged area.

Treatments for Valve Disorders

Treatment of valve disorders may vary dependent on which valve is affected. However, generally, treatment options that are available include [167]:

Medication. Mild heart valve disorders can often be managed through medication. Medications that are frequently prescribed for heart valve diseases include vasodilators, statins, diuretics, and anticoagulants.

Balloon valvuloplasty. This treatment may be used to treat valve stenosis.

Valve repair or replacement. If an individual is suffering from a severe valve disorder, surgery may be a viable option. The valve may be able to repaired, or replaced with a valve made of synthetics.