The evaluation of chest pain is a critical step in the careof women with heart disease. It is a point at which women arelikely to be treated differently from men,1,2,3,4,5,6 especiallywhen the diagnosis has not been established. Among patientsknown to have coronary artery disease, differences in the caregiven the two sexes are much less sharp. Physicians may be puzzledabout how to incorporate into clinical care new data on differentpatterns of treatment for men and women.
In the study of coronary heart disease, women have often beenexcluded from clinical trials or studied in . . . [Full Text of this Article]
Major Determinants of the Presence of Coronary Heart Disease
Chest Pain
Hormonal Status
Diabetes Mellitus
Peripheral Vascular Disease
Intermediate Determinants of the Presence of Coronary Heart Disease
Hypertension
Smoking
Lipoproteins
Minor Determinants of the Presence of Coronary Heart Disease
Age of More Than 65 Years
Obesity
Sedentary Lifestyle
Family History
Other Risk Factors
Estimating the Likelihood of Coronary Heart Disease
Initial Diagnostic Tests
Further Testing
Conclusions
Source Information
From the HarvardThorndike Laboratory, Cardiovascular Division, Beth Israel Hospital and Harvard Medical School, Boston.
Address reprint requests to Dr. Douglas at Beth Israel Hospital, 330 Brookline Ave., Boston, MA 02215.
References
Related Letters:
Chest Pain in Women
Auerbach I., Chouraqui P., Motro M., Douglas P. S., Ginsburg G. S.
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N Engl J Med 1996;
335:820-821, Sep 12, 1996.
Correspondence
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[Full Text]
Auerbach, I., Chouraqui, P., Motro, M., Douglas, P. S., Ginsburg, G. S.
(1996). Chest Pain in Women. NEJM
335: 820-821
[Full Text]