Book Review

Women and Heart Disease

N Engl J Med 1998; 339:780September 10, 1998

Article

Women and Heart Disease
Edited by Desmond G. Julian and Nanette Kass Wenger. 454 pp., illustrated. London, Martin Dunitz, 1997. (Distributed by Mosby, St. Louis.). $124. ISBN: 0-85317-287-1

The difficulty of finding comprehensive data on women and cardiovascular disease makes this a timely and welcome book. In the introduction, the editors state that heart disease is the most common cause of death among women, yet this fact is not widely appreciated by women themselves or by the medical professionals who care for them. One temptation in compiling a book such as this would be to concentrate exclusively on the wealth of new data on the effects of female hormones in the cardiovascular system, particularly in relation to coronary heart disease. This book covers that subject very well, but it also deals with many different issues relevant to heart disease in women. For example, problems concerning differences between men and women in imaging tests and in outcomes after invasive therapy are addressed comprehensively in their respective chapters.

This book therefore achieves a good balance in its exploration of heart disease in women. There are interesting chapters on heart disease and pregnancy, heart failure, and cardiac transplantation, as well as on arrhythmias (a subject that few studies have specifically addressed). Some chapters point out deficiencies in current knowledge and may therefore usefully stimulate research in these areas. The majority of the authors, as experts in their fields, give authoritative reviews of their subjects. Certain topics will require more research, as the authors emphasize. It is often very difficult to dissect from the literature the subtle nuances in the diagnosis, management, and therapy of heart disease in women, but this is one objective the book achieves very well. Even though the references are not completely up to date, the chapters cover their topics adequately. Recent basic work on vascular estrogen receptors has not been included, but the book suffers little because of this.

The book extends into little-known but important areas such as congenital heart disease in women. I particularly enjoyed the chapters in which authors present data that may help readers improve their general care of women with cardiovascular disease. These interesting and informative chapters deal with topical issues, such as the widespread exclusion of women from clinical trials. Some of the topics covered are unexpected but will be very useful as a reference and will succeed in updating readers very quickly; for example, the chapters on genetic disorders, imaging, and rehabilitation are excellent. One of the problems in editing a book such as this is to ensure that chapters do not overlap too much. The editors have done their job well, and the unavoidable overlap tends to reinforce knowledge rather than to irritate the reader. The book fills many gaps in the available information about women and heart disease and will be a very useful addition to the bookshelf of any health care professional whose practice includes women.

Peter Collins, M.D.
National Heart and Lung Institute, London SW3 6NP, United Kingdom