Coronary artery disease (CAD) is often considered a “man’s disease,” but in fact, it is the leading cause of death in both sexes and kills more women than men. Despite the trends, providers are not as likely to suggest preventive measures for women, according to a research paper published in the June issue of Global Health. Women, the authors found, face other challenges in the fight against CAD as well, including factors specific to their sex.

The authors, Kavita Sharma, MD, and Martha Gulati, MD, of The Ohio State University in Columbus, summarized the available literature about women and CAD.

Around the world, women make up 8.6 million of the 17.3 million deaths from cardiovascular disease, and more women die from CAD than from cancer, chronic lower respiratory disease, Alzheimer’s disease and accidents combined.

“There has been some good news, in that from 1998 to 2008, the rate of death from CAD declined 30 percent in the U.S.A. (with similar falls in other developed countries); however, rates are actually increasing in younger women aged 55 years and under due to a variety of risk factors,” the authors said in a press release.

Over the years, research has found that CAD develops differently in women due to sex-specific risk factors.

“Women have been shown to have smaller coronary artery diameters than men do,” the authors wrote. These narrowed vessels, they explained, may lead to symptoms, even though they may not have major obstructions in their coronary arteries. In turn, they have more hospitalizations and coronary angiography.

Women may suffer more often from coronary plaque erosion and are less likely to have obstructive CAD that leads to heart attacks in men.

In addition, while a man’s risk increases linearly with age, a woman’s risk tends to increase exponentially after age 60.

Family history of CAD also plays a bigger role in the development of the disease in women—early onset of the disease in a first-degree female relative is a more important risk factor than early onset in male relatives.

Other traditional risk factors that place women at higher risk than men are diabetes, hypertension, dyslipidemia, physical inactivity and obesity.

Autoimmune diseases are also more prevalent in women and previous studies have linked rheumatoid arthritis and systemic lupus erythematosus to an increased risk of CAD.

Female hormones may differentiate women from men as well. Research has found a connection between ovulatory abnormalities, including polycystic ovarian syndrome, early onset of menstruation and functional hypothalamic amenorrhea, and CAD.

Other uniquely female medical issues also may raise CAD risk, including pre-eclampsia, gestational diabetes and breast cancer therapy. It is not clear, however, whether it is the therapy or the cancer itself that is associated with CAD risk.

Women, Sharma and Gulati concluded, are not treated as aggressively as men are, hence the higher mortality rate. Providers are more likely to recommend preventive treatments for men at a similar level of risk, such as lipid-lowering therapy, aspirin and suggestions for changing lifestyle habits.

Women are less likely to reach their target blood pressure and lipid numbers, and they are also less likely to participate in cardiac rehabilitation after a heart attack.

“Increasing data demonstrate that some treatment strategies have sex-specific effectiveness,” the authors wrote. “Further research regarding the pathophysiology of CAD in women, diagnosis and treatment strategies specific to women is required.”