During the International Congress on Women and Health organized by the Sakarya University in Sakarya, Turkey in 2010 with Dr Nurgül Keser as the Director and Dr Navin C Nanda as the International Director, it became clear that there was a need to publish an up-to-date book on heart disease in women taking into account the fact there was hardly any book on this subject. On our recommendation, Dr Nanda and Dr Keser undertook this difficult task and have come up with a book that will emphasize and focus attention on various aspects of heart disease in women and how they are underdiagnosed and undertreated compared to men. This will increase awareness and may spur efforts by various government agencies to tackle these mostly unrecognized issues affecting women throughout the world.

Our heartfelt thanks to Dr Nanda and all the national and international contributors of this book for taking time off from their busy schedule to collaborate on this very important project.

This book consists of a total of 34 chapters organized into 8 sections. The first two chapters by Rachana and Anand Kulkarni deal in a succinct manner the myths and facts about cardiovascular disease in women and the important topic of cardiovascular disease prevention. Both modifiable and non-modifiable risk factors and guidelines for prevention are discussed, with special reference to women. The third chapter by Sanne Peters and associates emphasizes sex differences in the effects of leading and most prevalent risk factors in women. This is followed by a chapter on dyslipidemia by Lale Tokgozoglu from Ankara, Turkey. Gopal Ghimire in the next chapter discusses various aspects of familial hypercholesterolemia with special focus on women and highlights the guidelines proposed by the National Lipid Association. Metabolic syndrome is next covered by Sibel Catirli Enar and colleagues. The epidemiology, pathophysiology and management of hypertension in women are elegantly summarized by Keith Ferdinand and Samar Nasser in the following chapter (Chapter 7). They also cover the important topics of resistant and refractory hypertension. Cardiac and non-cardiac causes of stroke in women are detailed in the next chapter by Nese Keser from Istanbul, Turkey. The relationship of oral contraceptive pills and hormone replacement therapy to stroke as well as risk factors for stroke during pregnancy are also discussed. Professors Nurgül Keser and Cevdet Erdöl in the next chapter discuss the deleterious effects of smoking in women, especially younger women in whom the prevalence of smoking is alarmingly increasing in many parts of the world. A special mention is made of the increasing use of waterpipe tobacco smoking in several countries of Europe and the Middle East. Measures taken by government agencies to curb smoking are also mentioned. Job stress, strain, burnout, unemployment and biomarkers and their relationship to some of these factors are delineated in Chapter 10 by Aryanna Jacobs and colleagues. The following chapter by Mackram Eleid and associates from the Mayo Clinic in Rochester describe the role of autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus and antiphospholipid antibody syndrome in atherosclerotic plaque formation in the next chapter. The last chapter in this section by Juliana Kling and associates is also from the Mayo Clinic and explains the effect of pregnancy and menopause on cardiovascular function and points to the controversial relationship of menopausal hormone therapy to progression of cardiovascular disease.

The second section of the book pertains to with coronary heart disease. The first chapter by Ezra Amsterdam provides a perspective and overview of coronary heart disease in women. The second chapter (Chapter 14) by Kumar Sanam and colleagues outlines the approach to assessment of chest pain in a woman presenting to the Emergency Department. The clinical presentation, diagnostic testing, the use of biomarkers and differential diagnosis are given in detail. The third chapter, from the group of Nanette Wenger, a renowned expert in heart disease in women, details all aspects of stable ischemic heart disease in women including pathophysiology of gender differences in women, different terminologies used, the scope of the burden, challenges in diagnosis and treatment strategies. 14The last chapter in this section, by Ankit Mehra and Kul Aggarwal, explains different aspects of acute coronary syndromes including the pathophysiology of atherosclerotic plaque rupture and erosion and different modalities of treatment with special reference to management in a pregnant woman.

Section 3 of the book deals with noninvasive testing. Jennifer Kiessling and colleagues from the University of Alabama at Birmingham outline the use of echocardiography in the diagnosis of various acquired and congenital structural heart lesions in women. In particular, the use of stress echocardiography in the assessment of coronary artery disease is highlighted. Echocardiography in the pregnant woman and its usefulness in the assessment and management of fetal cardiac anomalies are also delineated. The next chapter in this section (Chapter 18) by Francesca Mantovani and associates outline factors affecting the accuracy of diagnostic testing in women and the advantages and disadvantages of various modalities used for noninvasive stress testing including contrast stress echocardiography. The last chapter in this section by Suman and Manish Tandon focuses in detail on the use of radionuclide stress imaging techniques in the evaluation of ischemic heart disease. Radiation considerations are also mentioned.

The fourth section of this book relates to heart failure, cardiomyopathy and pericarditis in women. Cynthia Taub and colleagues from Ileana Piña’s group provide a comprehensive review of the etiology, pathophysiology, diagnostic assessment and management issues of heart failure in women in the first chapter of this section. Heart failure in pregnancy is also covered. In the next chapter (Chapter 21), Anant Kharod reviews myocarditis and pericarditis with particular emphasis in women. The etiology, clinical manifestations, diagnosis and treatment options are discussed. The last chapter of this section by Keli Chaviano and colleagues covers all aspects of Takotsubo cardiomyopathy which is characteristically seen in postmenopausal women.

Section 5 of the book deals with arrhythmias in women. Deepika Narasimha and Anne Curtis describe in great detail sex-based differences in the epidemiology, prevalence, clinical manifestation, and management of various types of arrhythmias including atrial fibrillation and ventricular tachycardia. This chapter is followed by another one (Chapter 24) by Anurag Singh which specifically discusses ventricular arrhythmias and sudden death in women.

The next section (Section 6) consists of chapters on rheumatic heart disease and valvular heart disease in women. The first chapter by Anita Saxsena from New Delhi, India, highlights the problem of rheumatic heart disease in the developing countries and the fact that rheumatic mitral stenosis is much more prevalent in women than men. Various sequele of rheumatic heart disease including its management in pregnancy are given in this chapter. The next chapter by Vijayalakshmi and Chitra Narasimhan provide a detailed review of valvular heart disease in women and this is supplemented by a large number of illustrations depicting various pathological findings. Prosthetic valves are also covered in this chapter. The last chapter in this section (Chapter 27) by Peter Block deals with gender differences in the outcome of the relatively recently developed technique of transcatheter aortic valve replacement.

Section 7 of the book describes heart diseases in pregnancy and congenital cardiac lesions frequently seen in women. The first chapter by Akila Subramaniam and Joseph Biggio mentions various physiological changes in the cardiovascular system that occur during pregnancy as well as evaluation and management of acquired and congenital cardiac diseases during pregnancy. A different perspective on the same subject is provided by Reema Chugh in the next chapter (Chapter 29). Next, Lori Blauwet elegantly discusses all aspects of the important topic of peripartum cardiomyopathy. The last chapter in this section, also by Reema Chugh, deals with congenital heart lesions in women. It represents a detailed review of issues pertaining to acyanotic and cyanotic women with congenital heart disease.

The last section (Section 8) of the book covers miscellaneous topics. Peripheral arterial disease in women is reviewed by Amy Pollak and Sharon Mulvagh. Diagnostic testing including the use of ankle-brachial index, gender differences in its values and guidelines used in the management are provided in this chapter. Charu Gandotra, in the next chapter, discusses cardiovascular implications of cancer in women. He focusses on commonly used chemotherapeutic agents with potential for cardiac toxicity and various strategies employed for its identification and management. The last chapter of this section and book (Chapter 34) by Stephanie El-Hajj, Navin C Nanda and Fadi G Hage provides a summary of recently published literature on heart disease in women.

Because of the large number of contributors, some overlap of content and chapters is inevitable and does exist in the book. However, deliberately, no attempt was made by us to correct this as it was felt that some of it could provide a different perspective to the reader and would serve to reinforce important concepts and issues in the assessment of heart disease in women.