Ischaemic heart disease in the ageing woman

Cardiovascular disease is one of the leading causes of death worldwide. Since 1984, the total number of deaths from cardiovascular disease has been greater for women compared with men. This might be, in part, related to gender-specific differences in the presentation of people with chest pain but, importantly, the risk of heart disease in women is often underestimated owing to the misperception that women are ‘protected’ against cardiovascular disease. Studies have shown that medical services are underused, delays occur in health-care seeking behaviour, resource use patterns are less intensive, and it takes longer to diagnose women compared with men. This often leads to less aggressive treatment strategies which, in turn, may translate into poorer outcomes compared with those in men. In this chapter, we review the gender-specific differences in epidemiology, diagnosis, and management of people with ischaemic heart disease, and focus particularly on the effect of ageing and menopause in ischaemic heart disease.