Coronary heart disease (CHD) is the leading cause of death and disability among women in the United States.1 This issue of The Journal of Cardiovascular Nursing (15:3) addresses current knowledge concerning hormone replacement therapy and CHD; symptoms and diagnosis of heart disease in women; and outcomes, recovery, and ethnic concerns in women with CHD. The issue attempts to capture salient, contemporary topics relevant for nurses providing care to women with existing disease or at high risk for developing CHD, as well as for nurses conducting research with women and CHD.
The first article in this issue, "Hormone Replacement Therapy: Primary and Secondary Prevention" by Penckofer and Schwertz, summarizes the most current findings surrounding the role of hormone replacement therapy (HRT) in the prevention of CHD and the progression of disease in those with known CHD. This comprehensive review addresses evidence from epidemiologic studies and controlled clinical trials documenting the benefits and risks associated with HRT. In addition, the authors offer useful guidelines for the clinician prescribing HRT, including information on compliance issues.
The next article by McSweeney et al describes the results from a study to identify prodromal and acute symptoms associated with myocardial infarction (MI) in women. A combination of qualitative and quantitative methods helped to provide a unique picture of the full range of symptoms experienced by women. It is one of the first explorations of prodromal symptoms, defined by the authors as those symptoms that appear intermittently before the MI and change in frequency or intensity after the MI.
The diagnosis of CHD in women can present many challenges, including the selection of the appropriate diagnostic test. Deaton et al provide a review of diagnostic strategies for women with suspected coronary artery disease, comparisons of test performance, and a clinical pathway for testing and care of at-risk women. They present evidence for the diagnostic accuracy, prognostic ability, and cost-effectiveness of noninvasive modalities such as exercise electrocardiography, stress cardiac imaging, stress echocardiography, stress nuclear imaging, and electron beam computed tomography.
Gender differences in recovery following a cardiac event have been described in numerous quantitative and qualitative investigations. King reviews the quantitative literature comparing emotional and functional outcomes in women and men. Results are organized in terms of gender comparisons by major coronary events and the magnitude of functional or emotional outcome. Then, Fleury et al report the results of a study using qualitative methods to explore the experiences of women living with cardiovascular disease. They describe major themes and processes related to changing images of the self in a group of women who participated in weekly group sessions for 9 months following an acute coronary event.
Ethnic differences in women with CHD are addressed in the next two articles. Andrews et al highlight findings from the recently released publication entitled, Women and Heart Disease: An Atlas of Racial and Ethnic Disparities in Women.2 This atlas identifies the relationship between geography, race, ethnicity, gender, and the determinants of morbidity and mortality. The article describes the excessive mortality and morbidity in ethnic minority women in certain geographic areas and the implications for cardiovascular nurses with opportunities to implement primary and secondary prevention. Next, Wilbur et al address the challenges of recruiting women and minorities into clinical trials and suggest effective recruitment strategies. In addition, they compare the prevalence of cardiovascular risk factors in a cohort of African American and Caucasian midlife women who enrolled in a walking intervention study.
In the arrhythmia department, McCauley et al present an interesting case study of a women with coronary vasospasm accompanied by conduction deficits. In this final article of the issue they walk us through a diagnostic work-up and treatment program and provide a useful description of the pathophysiology of vasospasm-induced heart block.
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