Book Review

Women's Vascular Health

N Engl J Med 2007; 357:96-97July 5, 2007

Article

Women's Vascular Health
Edited by Ian A. Greer, Jeffrey Ginsberg, and Charles D. Forbes. 486 pp., illustrated. London, Hodder Arnold, 2007. $179.50. ISBN: 978-0-340-809976

When I first saw the title of this book, my immediate thoughts were of the timeliness of a resource that can easily relate the growing body of knowledge about women and vascular disease. When I opened to the table of contents, I realized that my perception of women's vascular health was fairly narrow. In the preface, the editors eloquently set the stage for the wonderfully surprising book that follows.

Written and edited by a unique combination of experts in obstetrics and gynecology, hematology, and medicine, Women's Vascular Health presents a view of vascular disease in women that is much more holistic than is often acknowledged. It not only addresses topics such as coronary and peripheral arterial disease but also discusses unique disease processes that may be precursors to coronary artery disease in women, such as the polycystic ovary syndrome. There is information on menstrual dysfunction, the effects of menopause, venous thromboembolism, hemorrhagic problems, and the cardiovascular effects of oral contraception and hormone-replacement therapies. In addition, classic problems of pregnancy, such as preeclampsia, are placed in a vascular context. As the editors aptly state in the preface, “A woman's vascular health is relevant throughout her life. . . . All too often, practitioners involved in managing these various problems see only a small aspect of it as it relates directly to their area of expertise.”

The timeliness of the book deserves emphasis. Women are just beginning to be fully understood as unique in relation to vascular disease. In the cardiovascular literature alone, new research has appeared on optimal therapies for acute coronary syndromes and carotid arterial disease in women, conditions that are not necessarily the same as in men. In this regard, the book does a remarkable job of assembling and incorporating even very recent pivotal clinical trial data that focus on women.

The chapters are grouped into three sections. The first section, an overview, presents traditional topics and novel ones, such as metabolic risk factors, genetic risk factors, and syndrome X. The first chapter in this section, which discusses the epidemiology of vascular disease in women, summarizes data from key studies and serves as an excellent introduction to the detailed chapters that follow. The quality of each subsequent chapter is high, with considerable depth of information and an emphasis on disease processes as they relate to women. The authors are experts in both their fields of research and the related clinical practice, a combination that is reflected in the content, which melds pragmatism with an evidence-based approach. In addition, although many advances have been made in women's vascular health, the editors would have been remiss not to emphasize the important areas requiring further investigation; these are highlighted in most chapters.

The second section, “Reproductive Problems,” expertly associates vascular processes with reproduction. The interesting information contained in these chapters ranges from the changes in lipid profile that occur during pregnancy to the importance of considering factor V Leiden heterozygosity in women who receive oral contraception (and who have 35 times the risk of venous thromboembolism as women without the factor). The chapter on structural heart disease in women before and during pregnancy offers information on physiology and guidelines for treatment, and it is up-to-date, explaining newly recognized disease processes such as peripartum cardiomyopathy. Other topics of interest include the management of coronary artery disease during pregnancy, since more women are now bearing children later in life. The third and final section of the book, which includes chapters on hormone therapy, summarizes the extensive data on this topic that have been published in the past decade.

Despite the diversity of the topics covered, the book is organized in a way that makes it easy for the reader to find a topic. In addition, the annotated reference list identifies key seminal primary articles and review papers as well as the first formal publication of management guidelines, thereby allowing the reader who is unfamiliar with a given topic to quickly access the references that will be most fruitful for an in-depth review.

The novel, multidisciplinary approach of Women's Vascular Health is a pleasant surprise. It correctly identifies the unique characteristics of women and their vascular health, making for a book that will help obstetricians, cardiologists, and primary care physicians alike offer a higher level of care to their female patients.

Ruchira Glaser, M.D.
Hospital of the University of Pennsylvania, Philadelphia, PA 19104
ruchira.glaser@uphs.upenn.edu