Cardiovascular Disease in Women Update: Ischemia, Diagnostic Testing, and Menopause Hormone Therapy

Endocr Pract. 2022 Feb;28(2):199-203. doi: 10.1016/j.eprac.2021.10.007. Epub 2021 Dec 31.


Objective: This update will address 3 areas specifically that are essential to improving cardiovascular outcomes for women.

Methods: The current literature has been reviewed and three important areas of cardiovascular care in women are highlighted. First is that even though women and men share many traditional risk factors for ischemic heart disease, several of these risk factors affect women disproportionately when it comes to CVD risk and events. There are also unique sex-specific risk factors for women and risk factors that are more common in women than in men. Adverse outcomes of pregnancy and hypertensive disorders of pregnancy are associated with an increased long-term risk of CVD and events. At menopause, cardiovascular risks increase, and lipids become unfavorable. Second is that diagnostic testing for ischemic heart disease presents different specificities and sensitivities between men and women and testing should be determined according to what is best and safest for women. Third is that currently, menopause hormone therapy is approved by the U.S. Food and Drug Administration for the treatment of vasomotor and genitourinary symptoms, prevention of osteoporosis, and estrogen replacement in the setting of surgical menopause, hypogonadism, or premature ovarian insufficiency. It is not recommended for the primary or secondary prevention of CVD and not recommended for women with high atherosclerotic CVD risk.

Results: Cardiovascular disease (CVD) remains the most common cause of death in women in the United States despite tremendous improvements in cardiovascular care for men and women. The prevention of CVD in women with early detection and implementation of preventive therapies before atherosclerotic CVD develops is critical to improving outcomes for women.

Keywords: adverse pregnancy outcomes; cardiovascular risk factors; hormone therapy; menopause; stress testing.

Publication types

  • Review

MeSH terms

  • Cardiovascular Diseases* / epidemiology
  • Diagnostic Techniques and Procedures
  • Estrogen Replacement Therapy
  • Female
  • Hormone Replacement Therapy
  • Humans
  • Ischemia
  • Male
  • Menopause
  • Pregnancy
  • Risk Factors
  • United States