Cardiovascular disease (CVD) is the number one cause of death in the United States and in women (AHA 2001). Despite this fact, early heart studies notoriously excluded women, partly due to concerns about exposing fertile women to the same radiation-based imaging, invasive surgeries, and medication side effects as men (Ting, McLartey, and Andersen 1999). The more lingering mantra is that estrogen confers immunity to cardiovascular disease. There is a lot to be said for the power of myths in a civilized society. The belief that heart disease is a man's problem and women are more likely to survive a heart attack is not an unfamiliar attitude in the current medical arena. It is true that cardiovascular events cause most deaths in men and women's heart disease presents ten to fifteen years later than men, but, in retrospect, cardiovascular disease has always been an equal opportunity threat. At least one-half million women die in the United States each year, and cardiovascular disease unequivocally ranks as the leading culprit, with a commanding chasm between it and the next nine causes of death (Haran 2003). Today, this crippling disease appears to affect more women than men (Centers for Disease Control and Prevention [CDC] 1998). The American Heart Association (AHA) reports that more women than men have died of heart disease every year since 1984. The second leading cause of mortality is breast cancer, which kills one in twenty-six women, compared to one in two from CVD (McKeown 2000). As if these staggering statistics were not enough, women also simultaneously suffer from one or more types of cardiovascular illnesses more frequently than men.
One would expect pathology in the incarcerated patient to be a direct sampling of the surrounding community, but such is not so for CVD in women. Women make up such a small percentage of the confined population that, in spite of an increasing rate of incarcerations, there is a dearth of information available regarding their cardiovascular status. Most studies only address substance abuse, mental health problems, and sexually transmitted infections in women behind