Diabetes mellitus and cardiovascular disease in women.

Abstract

WHILE coronary heart disease (CHD) has generally been considered a disease affecting men, the World Health Organization in 1990¹ reported that heart disease is the leading cause of death for women of all ages in the United States. This disease accounts for nearly 30% of all deaths among women.^2,3 The incidence of CHD in women rises exponentially with age in industrialized, westernized societies.⁴ Below the age of 55 years, the incidence of CHD in women is one third that of men; however, this ratio approaches unity at age 75 years. Indeed, more than a quarter of a million women aged 50 through 79 years die of CHD in the United States each year. As discussed in this article, the rising incidence of CHD parallels increases in the incidence of both hypertension and diabetes with increasing age in the United States.^4-9 Since, as previously extensively reviewed,^8-10 the mortality from CHD and myocardial infarction is significantly worse in women than in men, it is important that we better understand the underlying factors that predispose women both to CHD and associated mortality.¹¹ This article examines those underlying factors with special attention to the important role of diabetes mellitus in promoting CHD and associated mortality in women.