Women and Ischemic Heart Disease: Evolving Knowledge
By L. Shaw, R. Bugiardini, C. Merz. Journal of the American College of Cardiology, 2009
673 citations recorded by the source corpus.
Evolving knowledge regarding sex differences in coronary heart disease (CHD) is emerging. Given the lower burden of obstructive coronary artery disease (CAD) and preserved systolic function in women contrasted by higher rates of myocardial ischemia and near-term mortality compared to men, we propose the term ischemic heart disease (IHD) as appropriate for this discussion specific to women, rather than CAD or CHD. This paradoxical difference where women have lower rates of anatomical CAD but more symptoms, ischemia, and outcomes appear linked to coronary reactivity which includes microvascular dysfunction. Novel risk factors can improve the Framingham risk score, including inflammatory markers and reproductive hormones, as well as noninvasive imaging and functional capacity measurements. Risk for women with obstructive CAD is elevated compared to men, yet women are less likely to receive guideline-indicated therapies. In the setting of non-ST elevation acute myocardial infarction, interventional strategies are equally effective in biomarker positive women and men, while conservative management is indicated for biomarker negative women. For women with evidence of ischemia but no obstructive CAD, anti-anginal and anti-ischemic therapies can improve symptoms, endothelial function, and quality of life; however trials evaluating adverse outcomes are needed. We hypothesize that women experience more adverse outcomes compared to men because obstructive CAD remains the current focus of therapeutic strategies. Continued research is indicated to devise therapeutic regimens to improve symptom burden and reduce risk in women with IHD.
Subfields: Cardiology and Cardiovascular Medicine, Public Health, Environmental and Occupational Health, Radiology, Nuclear Medicine and Imaging
View Paper: https://www.semanticscholar.org/paper/25c82fdbe30cb6715986f427f807995b5c6478ee
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In Public Health, Environmental and Occupational Health
Citations in the corpus
- Cardiovascular disease in women (2010, neutral): “IHD in women includes not only atherosclerotic obstructive CAD, but also an expanded spectrum of coronary disease, including coronary microvascular dysfunction (CMD), endothelial dysfunction, vasomotor abnormalities, spontaneous coronary artery dissection (SCAD) and stressinduced cardiomyopathy.(142”
- Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry (2012, background): “cularization in women in CLARIFY, and they also have less severe disease, with lower rates of multivessel disease.(34) There are higher rates of microvascular disease in women.”
- Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. (2016, background): “CAD or structural heart disease occur more frequently in women than in men.(9) In particular, younger women with ACS may present with open coronary arteries, with plaque erosions with distal em-”