This is one of the most fascinating questions clinical epidemiologists are asking themselves.

There is a well-defined gender gap when it comes to an analysis of risks, diagnosis and treatment of coronary heart disease. This article will attempt to reconstruct the factors responsible for this gender gap, and provide some hints on preventing heart disease for both sexes.

What are the causes of the gender gap for heart attack?

"Men are from Mars, Women from Venus" - Gray JM

Traditionally, men and women have played different roles in society. These roles result in exposure to a different set of influences. These in turn act on the organ systems in different ways.

Unhealthy behaviour patterns

Men have been exposed to a higher risk of unhealthy patterns in their lifestyles. Smoking, alcohol consumption, eating a lot of red meat and less of fruits and vegetables are more commonly seen in males. These factors however are only contributory, and not causative, of coronary disease.

Work outside home

While it has been suggested that work stresses are in a large part responsible for coronary heart disease, recent studies focussed on working women draw different conclusions. For instance, the heart disease risk has been shown to be higher only in subordinate, clerical posts. Successful working women are NOT at a higher risk.

One special aspect of heart disease preventive intervention is specific to post-menopausal women and involves replacement of estrogens.

At menopause, due to atrophy of the glands called ovaries, the level of the female hormone estrogen decreases. This leads to several effects that collectively produce the post-menopausal syndrome. Estrogens are also partly responsible for the lower risk that women have for heart disease as compared to men.

Estrogen replacement therapy is considered in postmenopausal women, especially in those with multiple risk factors for coronary artery disease, such as elevated LDL. Recommendations are individualized in accordance with other health risks.