WOMEN 'S HEALTH AND MENOPAUSE : - National Heart, Lung ...

eases preoperatively. Quality of life was improved
on all postoperative occasions for both sexes.
Improvement in the physical activity score was
greater in males, although this was not significant.
It appears that the quality of life is significantly
improved after CABG surgery in both sexes, and
there appears to be a complex association between
improvement in various aspects of quality of life
and gender. 205 Women’s patterns of exercise following
cardiac rehabilitation are well below the recommended
guidelines for exercise after cardiac
events. 207 In 40 women who had MI or CABG
surgery, exercise frequency and duration intensity
were measured. In a 3-month study, only 50 percent
of the women were still exercising regularly,
suggesting that there is considerable room for
improvement in establishing exercise regimens
after MI or CABG surgery. Women are less likely
to be referred to rehabilitation.
Despite similar
stroke rates, women
are more likely than
men to die of
stroke, and this is
possibly related to
the age at which
stroke presents.
About 16 percent of
women die of stroke
compared with only
164
8. HEART FAILURE
Despite a similar prevalence of
heart failure in women compared
with men, 208 women have
largely been excluded from
clinical trials of heart failure. As
discussed earlier, women tend
to be older at presentation with
cardiac disease and may fall
outside recruitment guidelines.
Secondly, women are more likely
than men to have diastolic
heart failure and may be excluded
when systolic ejection fraction
is an entry criterion.
Two large studies have reported
improved survival in women
with heart failure. 209,210 8 percent of men.
Of the
randomized trials with beta-blockers in heart failure,
the U.S. Carvedilol Heart Failure Study group
found a statistically significant reduction in the
number of deaths in both women and men with
heart failure. 211 Other large beta-blocker trials have
not been able to discern a sex-specific mortality
difference. 212–214 In the trials of ACE inhibitors in
heart failure, the Cooperative North Scandinavian
Enalapril Survival Study (CONSENSUS-I) did not
show a reduction in mortality in women. 215,216
However, most trials contain such small numbers
of women that they are unable to discern a specific
mortality benefit for women. A meta-analysis of
ACE inhibitor trials has shown a similar survival
benefit for both women and men. 217 In the Acute
Infarction Ramipril Efficacy (AIRE) study of
ramipril in patients with post-MI left ventricular
dysfunction, there was a significant mortality benefit
in both sexes. 218 Three other studies of ACE
inhibitors in patients with left ventricular dysfunction
after MI did not show a significant mortality
benefit for women. Again, this may be due to the
relatively small numbers of women included in
these trials. 219–221
9. STROKE
Despite similar stroke rates, 222 women are more
likely than men to die of stroke, and this is possibly
related to the age at which stroke presents.
About 16 percent of women die of stroke compared
with only 8 percent of men. 222 Age is an
important predictor of survival in stroke victims,
and as the incidence of stroke is increased in older
women, this contributes to the adverse mortality.
The main risk factors for stroke are fairly consistent
and nongender dependent. Hypertension probably
is the most important, with diabetes mellitus,
cigarette smoking, CHD, atrial fibrillation, and
transient ischemic attacks comprising the major
other risk factors. 223 Hypertension is a major risk
factor for stroke, with about a 45-percent increase
in stroke risk for every 8 mmHg increase in diastolic
blood pressure. 19 Unlike many cardiovascular
trials, hypertension treatment has been definitively
shown to substantially reduce the morbidity and
mortality in women following stroke. Studies such
as the Swedish Trial in Old Patients (STOP) and