Introduction
Do women have equal access to all the components of health care for heart disease? In terms of prevention (i.e., assessing and, if possible, modifying risk factors), it is common knowledge that men over 40 years old are at high risk for coronary artery disease; yet, it is often forgotten that postmenopausal women who are not receiving hormone replacement therapy are also at high risk. 10, 11 Premenopause is, in general, a very coronary-protective state, but once menopause has occurred, the risk of disease in women becomes similar to that in men. Most women who develop coronary artery disease are at least 10 years older than men with such disease. Women live longer than men, and the risk of developing or dying from coronary artery disease increases with age.
Treatment and Prevention
Patients with stable angina have symptoms usually after physical activity or during periods of emotional stress. Angina can also be triggered by a dream, by eating a large meal, and by exposure to cold. Any increase in heart rate, blood pressure, contractile state, or ventricular wall tension can raise myocardial oxygen demand. When supply lags behind demand, angina results. When stable angina is diagnosed, pharmacologic therapy can be prescribed to reduce myocardial oxygen demand and to increase blood flow to ischemic areas of the myocardium. However, a patient's risk factors and the extent of underlying disease must be determined before a specific treatment decision is made.
Treatment usually comprises pharmacologic agents from three classes, alone or in combination: nitrates, beta-adrenergic antagonists (beta blockers), and calcium channel blockers. There is growing evidence that angiotensin-converting enzyme (ACE) inhibitors may also be beneficial, especially in reducing future risks of coronary events. Because of their positive effects on morbidity and mortality, beta blockers should be strongly considered as initial therapy for chronic stable angina..............
