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The Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women

  • LaPrincess C. Brewer
  • Rosalyn O. Adigun
  • Sharon L. Mulvagh
Chapter

Abstract

It has been almost a quarter century since the first scientific statement on cardiovascular disease in women was published, yet cardiovascular disease remains the leading cause of death in women. Women often present with atypical symptoms which delays recognition, diagnosis and treatment. The complex interplay of gaps in knowledge, sparse sex-specific outcomes data, and limitations of current guidelines lead women to suffer poorer clinical outcomes, with higher cardiovascular morbidity and mortality. While efforts to increase awareness of differences in the presentation of heart disease in women have improved our ability to evaluate women with ischemic symptoms, sex-specific differences in the pathophysiology of heart disease continue to create diagnostic and therapeutic enigmas. As our knowledge of the differential impact of traditional risk factors in women continues to grow, a paucity of sex-specific outcomes data precludes the implementation of evidence-based interventions into clinical practice. More recently, emerging data on non-traditional risk factors unique to and/or more commonly found in women is also shedding new light on the increased burden of disease among younger women, and is an area for future research and interventions. Ultimately, there remains a need for sex and evidence-based diagnostic and therapeutic strategies to address the variances in disease presentation, pharmacokinetic and pharmacodynamics differences in women compared to men, and to identify prognostic markers that can be targets for long-term monitoring. In the interim, we need to ensure that available resources for anatomic and functional assessments of cardiovascular disease are not underutilized in women. This updated review discusses the current challenges of prevention, diagnosis and treatment of ischemic heart disease in women.

Keywords

Women Ischemic heart disease Coronary artery disease Cardiovascular diseases Epidemiology Disparities Cardiovascular risk Diagnosis Treatment 

Abbreviations

ACC

American College of Cardiology

ACEI

ACE inhibitors

ACS

Acute coronary syndromes

AHA

American Heart Association

ARB

Angiotensin receptor blockers

ARIC

Atherosclerosis Risk in Communities

ASCVD

Atherosclerotic cardiovascular disease

ATP

Adult Treatment Panel

CABG

Coronary artery bypass grafting

CAC

Coronary artery calcium

CAD

Coronary artery disease

CASS

Coronary Artery Surgery Study

CCTA

Coronary computed tomographic angiography

CMR

Cardiac magnetic resonance imaging

CONFIRM

Coronary CT Angiography Evaluation for Clinical Outcomes

CVD

Cardiovascular disease

CT

Computed tomography

ECG

Electrocardiogram

ELITE

Early versus Late Intervention Trial with Estradiol

ETT

Exercise treadmill test

FRS

Framingham risk score

HERS

Heart and Estrogen/Progestin Replacement Study

hsCRP

High-sensitivity C-reactive protein

IHD

Ischemic heart disease

IOM

Institute of Medicine

ISCHEMIA

International Study of Comparative Health Effectiveness and Invasive Approaches

KEEPS

Kronos Early Estrogen Prevention Study

MACE

Major adverse cardiac events

MHT

Menopausal hormone therapy

MI

Myocardial infarction

MPI

Myocardial perfusion imaging

MVD

Microvascular disease

NCDR

National Cardiovascular Data Registry

NHANES

National Health and Nutrition Examination Survey

NHLBI

National Heart Lung and Blood Institute

PCE

Pooled Cohort Equation

PCI

Percutaneous coronary intervention

PCOS

Polycystic ovarian syndrome

PET

Positron emission tomography

PRHI

Peripheral reactive hyperemia index

PROMISE

Prospective Multicenter Imaging Study for Evaluation of Chest Pain

ROMICAT

Rule Out Myocardial Infarction using Computer Assisted Tomography

SCORE

Systematic Coronary Risk Evaluation

SPECT

Single-photon emission computed tomography

WHI

Women’s Health Initiative

WISE

Women’s Ischemia Syndrome Evaluation

WOMEN

What is the Optimal Method for Ischemia Evaluation in Women

Notes

Acknowledgment

The authors are grateful to Mrs. Debra Ward and Mrs. Rebecca Olson for their precious assistance with chapter preparation. Dr. Brewer is supported by the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Scholars Program (award number K12 HD065987-07) from the National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH), Mayo Clinic Women’s Health Research Center.

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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • LaPrincess C. Brewer
    • 1
  • Rosalyn O. Adigun
    • 2
  • Sharon L. Mulvagh
    • 1
    • 3
  1. 1.Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterUSA
  2. 2.Cardiovascular Diseases Fellow, Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterUSA
  3. 3.Division of Cardiology, Department of MedicineDalhousie University, Nova Scotia Health AuthorityHalifaxCanada

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