Preventive cardiology and cardiac rehabilitation programmes in women

Cardiovascular diseases are the most common cause of death among women. Women historically under-appreciate these risks. There are key differences in terms of the relative importance of risk factors, particularly in the age of presentation. The female ‘gender advantage’ previously felt to be due to female sex hormones remains unexplained. The effects of post-menopausal hormone replacement also remain controversial. Risk can be reduced by sensible risk-factor control, but there is an ongoing imbalance between calculated risk and evidence of subclinical atherosclerosis and in women, in particular, a more proactive approach to risk reduction may be required. The controversy surrounding the effectiveness of statins in women is probably more due to problems with meta-analyses than from gender dimorphism. Cardiac rehabilitation reduces cardiac risk but women have previously been under-referred, although the benefits are equally great in both genders.