There is increasing evidence to suggest that multiple factors, including heredity, occupation, diet, stress, and preexisting hypertension, diabetes mellitus, hypercholesterolemia, and obesity, are involved in the pathogenesis of coronary heart disease. It has also been observed for many years that women have less coronary disease than men. As long ago as 1803, William Heberden recorded that there were only 3 women in nearly 100 patients with pectoris dolor (angina pectoris).1 In a series of 30,000 autopsies, Clawson found a malefemale ratio of 8:1 among patients with coronary sclerosis without hypertension.2 Clinical studies of coronary heart disease have also shown a sex difference, Levy and Boas3 reporting a male-female ratio of 4.9:1, and Master, Dack, and Jaffe4 reporting 3.4:1. These studies have confirmed the observation that women have a decreased incidence of coronary atherosclerosis as compared with men.
Even more striking is the rarity of this disease in women under 40
ROGER W. ROBINSON, NORIO HIGANO, WILLIAM D. COHEN. Increased Incidence of Coronary Heart Disease in Women Castrated Prior to the Menopause. AMA Arch Intern Med. 1959;104(6):908–913. doi:10.1001/archinte.1959.00270120064010