Coronary Disease in Women: Evidence-Based Diagnosis and Treatment (Contemporary Cardiology)

It is now generally recognized that clinical trial investigators and research scientists at the molecular, genetic, and cellular levels need to perform more detailed gender-based research in order to understand how sex-based differences impact women's health, illness, and health care. In Coronary Disease in Women: Evidence-Based Diagnosis and Treatment, leading authorities and clinical experts review the data concerning coronary disease in women and provide a clinical management approach to the care of women with known or suspected coronary artery disease. Whereas earlier books have focused on gender-based differences in the epidemiology of coronary disease, or on gender bias in its treatment, the present work focuses on the daily, evidence-based clinical management of coronary disease in women. Working from the recommendations of the landmark Institute of Medicine's report, Exploring the Biological Contributions to Human Health: Does Sex Matter?, the authors apply the latest epidemiological findings and diagnostic tools to the evaluation of stable chest pain and acute ischemic syndromes in women. They also detail the therapeutic effectiveness of various treatments in women, such as coronary revascularization, electrophysiology, exercise training and cardiac rehabilitation, and menopausal hormone therapy. Additional chapters examine the effects of gender bias in diagnosis and treatment, the role of gynecologists as primary care physicians for women, health technology assessment in an era of managed care, and the problems of analyzing cost-effectiveness in the diagnosis and treatment of coronary artery disease in women. Authoritative and timely, Coronary Disease in Women: Evidence-Based Diagnosis and Treatment provides primary care physicians, cardiologists, family practitioners, gynecologists, and internists with an up-to-date guide to the optimal management of coronary disease in women today. Provides A Clinical Management Approach To The Care Of Women With Known Or Suspected Coronary Artery Disease Using An Evidence-based Approach. The Authors Provide Special Management Issues With Women In Developing Clinical Pathways Including Those Of Primary And Secondary Prevention Of Coronary Heart Diseases. It Covers The Screening And Diagnosis Of Coronary Disease In Women With Chapters On Epidemiology, Varying Symptom Presentation, And Choosing The Best Diagnostic Tests Based On Gender. Also Covered Are Disease Management Issues Including The Variations Of Therapeutic Effectiveness In Women, The Evaluation Of Stable Chest Pain Syndromes In Women, And The Evaluation Of Acute Ischemic Syndromes. The Books Concludes With Chapters On The Economics And Policy Issues In Health Care Including The Issues Of Gender Bias, Working With Managed Care, And The Role Of Women's Health Centers In Providing Care, Making This A Useful Text For All Physicians Treating Coronary Disease In Women. 1. Institute Of Medicine Report, Women's Cardiovascular Health, And Evidence-based Medicine / Nanette K. Wenger -- 2. Evidence-based Medicine In The Assessment Of Women At Risk For Cardiovascular Disease / Leslee J. Shaw -- 3. Population-based Sex Differences In Disease Incidence And Prevalence / Brandi J. Witt And Veronique L. Roger -- 4. Risk Detection And Primary Prevention In Women / Lori Mosca And Leslee J. Shaw -- 5. Early Detection Of Coronary Artery Disease In Women: Role Of Coronary Artery Calcium Scanning With Ebt / John A. Rumberger -- 6. Heart Failure In Women: Epidemiology, Gender Differences In Pathophysiology, And Implications For Therapy / Daniel P. Morin, Marvin A. Konstam, Michael E. Mendelsohn And James E. Udelson -- 7. Diastolic Dysfunction In Women / Mary Norine Walsh And Mariell Jessup -- 8. Functional Capacity And Activities Of Daily Living In Women / Claire E. Pothier Snader And Michael S. Lauer -- 9. Special Considerations For Minority Women / Jennifer H. Mieres And Elizabeth Ofili -- 10. Clinical Risk Assessment In Women: Chest Discomfort. Report From The Wise Study / B. Delia Johnson, Sheryl F. Kelsey And C. Noel Bairey Merz -- 11. Quality-of-life Issues For Women With Coronary Disease / John Spertus And Darcy Green Conaway -- 12. Should All Women With Suspected Coronary Disease Undergo Stress Cardiac Imaging? / Anthony P. Morise -- 13. State-of-the-art Diagnostic Testing In Women: A Research Update / Leslee J. Shaw, B. Delia Johnson, Sharon Mulvagh, Jennifer H. Mieres, Rita F. Redberg And C. Noel Bairey Merz -- 14. Treatment Strategies For Women With Stable Angina / Paul R. Casperson, Leslee J. Shaw And Robert A. O'rourke -- 15. Improving The Diagnosis And Management Of Women With Coronary Disease In Primary Care Settings / Kimberly J. Rask -- 16. Evaluation Of Acute Chest Pain In Women / Andra L. Blomkalns, W. Brian Gibler And L. Kristin Newby -- 17. Acute Ischemic Syndromes: Differences In Presentation And Treatment In Women / Jane A. Leopold And Alice K. Jacobs -- 18. Effectiveness Of Coronary Revascularization: Gender And Racial Differences / Christi Deaton, Cherie L. Kunik And Eric Peterson -- 19. Electrophysiology: Treatment Considerations In Women / Michael S. Bailey And Anne B. Curtis -- 20. Exercise Training And Cardiac Rehabilitation For Women / Elisa Yuen Man Chiu, Maria Vivina T. Regis And Erika Sivarajan Froelicher -- 21. Menopausal Hormone Therapy: Is There Evidence For Cardiac Protection? / Nanette K. Wenger -- 22. Gender Bias: Is It Real And How Does It Affect Diagnosis, Management, And Outcome? / Thomas H. Marwick And Jonathan Chan -- 23. Role Of Women's Health Centers In Improving Access And Process Of Care / Susan Kendig And D. Douglas Miller -- 24. Obstetrician/gynecologists, Primary Care, And Cardiovascular Disease / William W. Hurd, Sheela Barhan And Robert E. Rogers -- 25. Health Technology Assessment In The Era Of Managed Care: Issues In Women's Health Care / Laura Sampietro-colom, Shawna Jackson, Erin Williams And Frank J. Papatheofanis -- 26. Issues In The Analysis Of Cost-effectiveness In The Diagnosis And Treatment Of Coronary Artery Disease In Women / Adam Atherly And Steven D. Culler. Edited By Leslee J. Shaw, Rita F. Redberg. Includes Bibliographical References And Index. CORONARY DISEASE IN WOMEN: Evidence-Based Diagnosis and Treatment......Page 4 PREFACE......Page 6 CONTENTS......Page 8 CONTRIBUTORS......Page 12 PART I. INTRODUCTION......Page 16 1 The Institute of Medicine Report, Women’s Cardiovascular Health, and Evidence-Based Medicine......Page 18 2 Evidence-Based Medicine in the Assessment of Women at Risk for Cardiovascular Disease......Page 24 A. Cardiovascular Epidemiology in Women......Page 32 3 Population-Based Sex Differences in Disease Incidence and Prevalence......Page 34 4 Risk Detection and Primary Prevention in Women......Page 44 5 Early Detection of Coronary Artery Disease in Women: Role of Coronary Artery Calcium Scanning With EBT......Page 62 6 Heart Failure in Women: Epidemiology, Gender Differences in Pathophysiology, and Implications for Therapy......Page 80 7 Diastolic Dysfunction in Women......Page 108 8 Functional Capacity and Activities of Daily Living in Women......Page 118 9 Special Considerations for Minority Women......Page 134 B. Varying Symptom Presentation in Women......Page 142 10 Clinical Risk Assessment in Women: Chest Discomfort. Report from the WISE Study......Page 144 11 Quality-of-Life Issues for Women With Coronary Disease......Page 158 C. Choosing the Best Diagnostic Test for Women......Page 174 12 Should All Women With Suspected Coronary Disease Undergo Stress Cardiac Imaging?......Page 176 13 State-of-the-Art Diagnostic Testing in Women: A Research Update......Page 188 A. Evaluation of Stable Chest Pain Syndromes in Women......Page 210 14 Treatment Strategies for Women With Stable Angina......Page 212 15 Improving the Diagnosis and Management of Women With Coronary Disease in Primary Care Settings......Page 230 B. Evaluation of Acute Ischemic Syndromes in Women......Page 240 16 Evaluation of Acute Chest Pain in Women......Page 242 17 Acute Ischemic Syndromes: Differences in Presentation and Treatment in Women......Page 258 C. Variations in Therapeutic Effectiveness in Women......Page 282 18 Effectiveness of Coronary Revascularization: Gender and Racial Differences......Page 284 19 Electrophysiology: Treatment Considerations in Women......Page 300 20 Exercise Training and Cardiac Rehabilitation for Women......Page 312 21 Menopausal Hormone Therapy: Is There Evidence for Cardiac Protection?......Page 336 PART IV. ECONOMICS AND POLICY ISSUES IN HEALTH CARE RELATED TO WOMEN......Page 364 22 Gender Bias: Is It Real and How Does It Affect Diagnosis, Management, and Outcome?......Page 366 23 The Role of Women’s Health Centers in Improving Access and Process of Care......Page 386 24 Obstetrician/Gynecologists, Primary Care, and Cardiovascular Disease......Page 402 25 Health Technology Assessment in the Era of Managed Care: Issues in Women’s Health Care......Page 416 26 Issues in the Analysis of Cost-Effectiveness in the Diagnosis and Treatment of Coronary Artery Disease in Women......Page 428 INDEX......Page 438 CORONARY DISEASE IN WOMEN: Evidence-Based Diagnosis and Treatment 4 PREFACE 6 CONTENTS 8 CONTRIBUTORS 12 PART I. INTRODUCTION 16 1 The Institute of Medicine Report, Women’s Cardiovascular Health, and Evidence-Based Medicine 18 2 Evidence-Based Medicine in the Assessment of Women at Risk for Cardiovascular Disease 24 PART II. SCREENING AND DIAGNOSIS OF CORONARY DISEASE IN WOMEN 32 A. Cardiovascular Epidemiology in Women 32 3 Population-Based Sex Differences in Disease Incidence and Prevalence 34 4 Risk Detection and Primary Prevention in Women 44 5 Early Detection of Coronary Artery Disease in Women: Role of Coronary Artery Calcium Scanning With EBT 62 6 Heart Failure in Women: Epidemiology, Gender Differences in Pathophysiology, and Implications for Therapy 80 7 Diastolic Dysfunction in Women 108 8 Functional Capacity and Activities of Daily Living in Women 118 9 Special Considerations for Minority Women 134 B. Varying Symptom Presentation in Women 142 10 Clinical Risk Assessment in Women: Chest Discomfort. Report from the WISE Study 144 11 Quality-of-Life Issues for Women With Coronary Disease 158 C. Choosing the Best Diagnostic Test for Women 174 12 Should All Women With Suspected Coronary Disease Undergo Stress Cardiac Imaging? 176 13 State-of-the-Art Diagnostic Testing in Women: A Research Update 188 PART III. MANAGEMENT OF CORONARY DISEASE IN WOMEN 210 A. Evaluation of Stable Chest Pain Syndromes in Women 210 14 Treatment Strategies for Women With Stable Angina 212 15 Improving the Diagnosis and Management of Women With Coronary Disease in Primary Care Settings 230 B. Evaluation of Acute Ischemic Syndromes in Women 240 16 Evaluation of Acute Chest Pain in Women 242 17 Acute Ischemic Syndromes: Differences in Presentation and Treatment in Women 258 C. Variations in Therapeutic Effectiveness in Women 282 18 Effectiveness of Coronary Revascularization: Gender and Racial Differences 284 19 Electrophysiology: Treatment Considerations in Women 300 20 Exercise Training and Cardiac Rehabilitation for Women 312 21 Menopausal Hormone Therapy: Is There Evidence for Cardiac Protection? 336 PART IV. ECONOMICS AND POLICY ISSUES IN HEALTH CARE RELATED TO WOMEN 364 22 Gender Bias: Is It Real and How Does It Affect Diagnosis, Management, and Outcome? 366 23 The Role of Women’s Health Centers in Improving Access and Process of Care 386 24 Obstetrician/Gynecologists, Primary Care, and Cardiovascular Disease 402 25 Health Technology Assessment in the Era of Managed Care: Issues in Women’s Health Care 416 26 Issues in the Analysis of Cost-Effectiveness in the Diagnosis and Treatment of Coronary Artery Disease in Women 428 INDEX 438

An authoritative guide to clinical management of women with known or suspected coronary artery disease. Using an evidence-based approach, the authors apply the latest epidemiological findings and diagnostic tools to the evaluation of stable chest pain and acute ischemic syndromes in women, and detail the therapeutic effectiveness of various treatments in women, such as coronary revascularization, electrophysiology, exercise training and cardiac rehabilitation, and menopausal hormone therapy. Additional chapters examine the effects of gender bias in diagnosis and treatment, the role of gynecologists as primary care physicians for women, health technology assessment in an era of managed care, and the problems of analyzing cost-effectiveness in the diagnosis and treatment of coronary artery disease in women.

American Cardiovascular Research Institute, Atlanta, GA. Reviews the data concerning coronary disease in women and provides a clinical management approach to the care of women with known or suspected coronary artery disease. Evaluates stable chest pain and acute ischemic syndromes and discusses therapeutic effectiveness. DNLM: Coronary Disease--Diagnosis. The recently released Institute of Medicine (IOM) report (1) Exploring the Biological Contributions to Human Health: Does Sex Matter? advocated the study of sex differences "from womb to tomb" to improve the quality and appropriateness of health care services for women.