Coronary heart disease in women.

Coronary heart disease results in a worse prognosis following a primary event in women than in men, thus demonstrating the critical importance of primary prevention in at-risk individuals beginning early in adulthood. A medical history, physical examination, laboratory determination of lipid and HbA1c levels, as well as assessment of psychosocial factors, including tobacco use, provide a good initial estimate of cardiovascular risk in women. Women with coronary ischemia often present atypically, without dramatic chest pain, but with more subtle symptoms. Assessing traditional risk factors, as well as long-term risk screening, may help identify the higher-risk patients for evaluation and treatment. Statin therapy is generally used to lower LDL-C, whereas antihypertensive therapy is selected based on patient comorbidities and drug side effects. Addressing lifestyle and psychosocial factors is an important part of a comprehensive plan for cardiovascular risk reduction in women.