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Cardiovascular disease mortality rates have decreased in men during the past 20 years, but have steadily increased in women. In the United States, >500,000 women die of coronary artery disease (CAD) every year. Although many factors can influence an individual's risk for CAD, some factors are unique to women, including reproductive status. Menopause is associated with significant elevations in serum cholesterol levels and a 3-fold increase in the risk of CAD. It has been suggested that these changes result from a reduction in the level of estrogen. However, recent data from prospective clinical trials have not found any evidence that hormone replacement therapy protects against cardiovascular disease. On the other hand, several studies have shown that, in women, lipid lowering with statin therapy can reduce coronary events. On the strength of these findings, the Beyond Endorsed Lipid Lowering with Electron-Beam Computed Tomography Scanning (BELLES) trial-a 1-year, multicenter, randomized, double-blind, parallel-group study-has been specifically designed to determine the benefits of aggressive statin therapy on the progression of atherosclerosis in postmenopausal women. [ABSTRACT FROM AUTHOR]

Women have a higher in-hospital mortality rate than men after percutaneous transluminal coronary angioplasty (PTCA). To determine reasons for this, we analyzed the outcome of PTCA at our institution from 1989 to 1995 for 5,989 patients (2,101 women). Women were older than men (66.8 +/- 10.9 vs 61.0 +/- 11.2 years, respectively; p <0.0001) and more likely to have diabetes mellitus, hypertension, or a history of congestive heart failure than men. In-laboratory complications at the time of PTCA were similar for women and men. During the first 24 hours after PTCA, women were more likely than men to become hypotensive (0.33% vs 0.08%, p = 0.04) and had a higher rate of vascular injury than men (1.6% vs 0.6%, p <0.001). More than 24 hours after the procedure, women had a significantly higher mortality rate (1.2% vs 0.52%, p = 0.017), which was no longer significantly different after adjustment for age (odds ratio 0.72, 95% confidence interval 0.39 to 1.32). Multivariate correlates of death >24 hours after PTCA were age, a prior history of congestive heart failure, vascular injury, and use of thrombolytic agents. Of those dying >24 hours after the procedure, 67% of women suffered a noncardiac-related death compared with only 10% of men (p <0.001). The noncardiac death rate was 0.8% for women and 0.05% for men. These deaths were related to renal failure, vascular complications, bleeding, hypotension, and stroke, especially hemorrhagic stroke. In conclusion, immediate procedural complications at PTCA were similar for women and men; however, mortality was higher for women >24 hours after PTCA and before discharge due to a higher rate of noncardiac death. [ABSTRACT FROM AUTHOR]

Cardiovascular disease mortality rates have decreased in men during the past 20 years, but have steadily increased in women. In the United States, >500,000 women die of coronary artery disease (CAD) every year. Although many factors can influence an individual's risk for CAD, some factors are unique to women, including reproductive status. Menopause is associated with significant elevations in serum cholesterol levels and a 3-fold increase in the risk of CAD. It has been suggested that these changes result from a reduction in the level of estrogen. However, recent data from prospective clinical trials have not found any evidence that hormone replacement therapy protects against cardiovascular disease. On the other hand, several studies have shown that, in women, lipid lowering with statin therapy can reduce coronary events. On the strength of these findings, the Beyond Endorsed Lipid Lowering with Electron-Beam Computed Tomography Scanning (BELLES) trial-a 1-year, multicenter, randomized, double-blind, parallel-group study-has been specifically designed to determine the benefits of aggressive statin therapy on the progression of atherosclerosis in postmenopausal women.

Predictors of increased risk for recurrent cardiac events and death after acute myocardial infarction include postinfarction myocardial ischemia, anterior location of the infarct, and non-Q-wave versus Q-wave infarction. Although coronary angioplasty is performed in patients with postinfarction ischemia to alleviate symptoms, the outcome according to location and type of infarction and the effect on prevention of subsequent myocardial infarction and death are not known. To determine if location and type of myocardial infarction provide prognostic information in patients with postinfarction ischemia, we analyzed morbidity and mortality during and after coronary angioplasty according to the location (anterior vs inferior) and type (Q-wave vs non-Q-wave) of myocardial infarction in 505 consecutive patients. The incidence of recurrent angina, repeat coronary angioplasty, coronary bypass surgery, reinfarction, and death during long-term follow-up after hospital discharge (mean 34 +/- 19 months) for the 440 patients with an initial successful angioplasty was also compared. During the procedure, there was no difference in the primary success rate or mortality among the different groups; however, more patients with anterior non-Q-wave myocardial infarction underwent emergent bypass grafting after unsuccessful coronary angioplasty (p = 0.001). Multivariate Cox proportional-hazards analyses controlling for age, gender, number of diseased vessels, location, type of infarction, and year of coronary angioplasty revealed that more patients with anterior infarction had > or = 1 cardiac event (repeat angioplasty, coronary artery bypass grafting, reinfarction, or death) than did those with inferior infarction (RR 1.80, 95% confidence interval [Ci] 1.22 to 2.65, p = 0.003).(ABSTRACT TRUNCATED AT 250 WORDS)