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