Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access
Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc
Journal website https://www.cardiologyres.org

Review

Volume 3, Number 5, October 2012, pages 193-204

Age- and Gender-Normalized Coronary Incidence and Mortality Risks in Primary and Secondary Prevention

Figures

Figure 1.
Figure 1. Exemples of primary relative risk in Italian men and women aged 45 - 49 (upper panel) and 60 - 64 (lower panel) years: the role of diabetes (D) versus its absence (ND) are clearly illustrated. Modified from [38]: relative risk is higher in younger diabetic women, although diabetes increases relative risk both in men and women.
Figure 2.
Figure 2. Prevalence of coronary artery disease by age and sex in United States in 1999 - 2004. There is an approximate displacement of 10 to 20 years between genders: rates in women aged more than 80 years approach those of men in the sixties. Modified from [40]
Figure 3.
Figure 3. Ischemic heart disease mortality by age and blood pressure. Information was obtained on each of one million adults (both sexes) with no previous vascular disease recorded at baseline in 61 prospective observational studies of blood pressure and mortality. During 12.7 million person-years at risk, there were about 56,000 vascular deaths (12,000 stroke, 34,000 ischemic heart disease (IHD), 10,000 other vascular) and 66,000 other deaths at ages 40 - 89 years. The study concluded that throughout middle and old age, usual blood pressure is strongly and directly related to vascular (and overall) mortality, without any evidence of a threshold down to at least 115/75 mmHg (here on X axis, related to IHD only). Modified from [42].

Table

Table 1. Risk Evaluation in Women: Take Home Messages
 
1.HDL-cholesterol, Lp(a) and triglycerides are strictly related to CAD, particularly in pre-menopausal period. HDL-cholesterol levels are inversely related to CV disease incidence and mortality.
2.Weight and glycemic control are effective to reduce CVD mortality in women from middle to older age.
3.Poor renal function has an important secondary predictive role in women.
4.Serum uric acid does not differentiate gender-related CVD incidences, although it increases with age.
5.Lost ovarian function or the efficacy of hormone replacement therapy has no definite roles. Iron loss/deficiency may explain relative protection from CAD in women.
6.Women show longer QT interval physiologically: anti-sympathetic drugs might be used more frequently.