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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses sex differences in risk factors for the development and assessment of coronary artery disease (CAD). Cardiovascular disease (CVD) risk factors are similar for men and women; however, the prevalence of these risk factors differs between the sexes. Hypertension is more common in women aged \u0026gt;?65 years. Physical inactivity rates are higher and smoking rates are lower in women. Diabetes is more prevalent and may impart a higher CVD risk in women [Kalyani RR et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ECoronary Artery Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EPamela Ouyang, MBBS, Johns Hopkins University, Baltimore, Maryland, USA, discussed sex differences in risk factors for the development and assessment of coronary artery disease (CAD). Cardiovascular disease (CVD) risk factors are similar for men and women; however, the prevalence of these risk factors differs between the sexes. Hypertension is more common in women aged \u0026gt; 65 years. Physical inactivity rates are higher and smoking rates are lower in women. Diabetes is more prevalent and may impart a higher CVD risk in women [Kalyani RR et al. \u003Cem\u003EDiabetes Care\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EThe American College of Cardiology (ACC) National Cardiovascular Data Registry reported that significant obstructive CAD is less common in women than in men (p \u0026lt; .0001) [Shaw L et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2008]. Among white women and men with angina and CAD, women had a higher in-hospital mortality rate but lower rates of treatment with coronary revascularization and aspirin.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EA Finnish study showed that the presence of angina and coronary artery diagnosed by either stress test or angiography was associated with higher mortality rates in women than in men aged 45 to 74 years [Hemingway H et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2006]. In a sample of 136,247 patients (28% women) from 11 acute coronary syndrome (ACS) trials, 30-day mortality rates were significantly higher among women with ST-segment elevation myocardial infarction (STEMI; adjusted OR, 1.15; 95% CI, 1.06 to 1.24; p \u0026lt;.005) and lower among women with unstable angina (adjusted OR, .55; 95% CI, .43 to .70; p \u0026lt; .005) compared with men with the same diagnoses [Berger JS et al. \u003Cem\u003EJAMA\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EWomen with chest pain have a lower rate of anatomic coronary disease but are hospitalized more often for persistent chest pain [Shaw L et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2009]. Women with atypical chest pain or chest pain with no obstructive CAD have an increased risk of adverse events [Gulati M et al. \u003Cem\u003EArch Intern Med\u003C\/em\u003E 2009; Robinson JG et al. \u003Cem\u003EAm J Cardiol\u003C\/em\u003E 2008]. Women with sudden cardiac arrest have significantly lower CAD rates and less severe left ventricular dysfunction than men [Chugh SS et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2009].\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EThe Framingham Risk Score (FRS) and American Heart Association\/ACC Cardiovascular Risk Guidelines Work Group pooled cohort risk equations are used to assess atherosclerotic CVD (ASCVD) risk [Goff et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2013]. Women, however, can be misclassified if these scores are used alone. Nontraditional factors that increase cardiovascular risk include a family history of premature CVD; high-sensitivity C-reactive protein \u2265 2 mg\/L; coronary artery calcification (CAC) score \u2265 300 Agatston units or \u2265 75th percentile for age, sex, and ethnicity; and ankle-brachial index \u0026lt; .9. Additional risk factors in women include menarche age, menopause age, and gestational diabetes or hypertensive disorders during pregnancy.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003EAnother recent study showed that a patient\u0027s predicted risk of cardiovascular events as assessed by the FRS could be modified with the CAC scoring [Erbel et al. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2010]. As a result, it possible to use CAC scores to reclassify intermediate-risk patients into either a higher (or lower) risk category.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EWomen with chest pain have a less severe extent of coronary obstruction than do men. Nonobstructive coronary disease is, however, associated with increased risk versus normal coronary arteries. Causes of chest pain other than ASCVD are more common in women. Risk stratification tools may misclassify some intermediate-risk women. Therefore, Dr. Ouyang concluded that additional testing should be considered in women with high levels of a single risk factor.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/24\/24.1.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzow63\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}