Women and ischemic heart disease: Recognition, diagnosis and management

Seong-Mi Park, C. Noel Bairey Merz

Research output: Contribution to journalReview article

8 Citations (Scopus)

Abstract

Cardiovascular disease is one of the most frequent causes of death in both males and females throughout the world. However, women exhibit a greater symptom burden, more functional disability, and a higher prevalence of nonobstructive coronary artery disease (CAD) compared to men when evaluated for signs and symptoms of myocardial ischemia. This paradoxical sex difference appears to be linked to a sex-specific pathophysiology of myocardial ischemia including coronary microvascular dysfunction, a component of the 'Yentl Syndrome'. Accordingly, the term ischemic heart disease (IHD) is more appropriate for a discussion specific to women rather than CAD or coronary heart disease. Following the National Heart, Lung, and Blood Institute Heart Truth/American Heart Association, Women's Ischemia Syndrome Evaluation and guideline campaigns, the cardiovascular mortality in women has been decreased, although significant gender gaps in clinical outcomes still exist. Women less likely undergo testing, yet guidelines indicate that symptomatic women at intermediate to high IHD risk should have further test (e.g. exercise treadmill test or stress imaging) for myocardial ischemia and prognosis. Further, women have suboptimal use of evidence-based guideline therapies compared with men with and without obstructive CAD. Anti-anginal and anti-atherosclerotic strategies are effective for symptom and ischemia management in women with evidence of ischemia and nonobstructive CAD, although more female-specific study is needed. IHD guidelines are not "cardiac catheterization" based but related to evidence of "myocardial ischemia and angina". A simplified approach to IHD management with ABCs (aspirin, angiotensinconverting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.

Original languageEnglish
Pages (from-to)433-442
Number of pages10
JournalKorean Circulation Journal
Volume46
Issue number4
DOIs
Publication statusPublished - 2016 Jul 1

Fingerprint

Myocardial Ischemia
Coronary Artery Disease
Guidelines
Ischemia
Exercise Test
Guideline Adherence
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensins
Enzyme Inhibitors
Cardiac Catheterization
Disease Management
Renin
Sex Characteristics
Aspirin
Signs and Symptoms
Coronary Disease
Cause of Death
Cardiovascular Diseases
Cholesterol
Lung

Keywords

  • Coronary artery disease
  • Guideline
  • Microvascular angina
  • Myocardial ischemia
  • Women

ASJC Scopus subject areas

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Women and ischemic heart disease : Recognition, diagnosis and management. / Park, Seong-Mi; Merz, C. Noel Bairey.

In: Korean Circulation Journal, Vol. 46, No. 4, 01.07.2016, p. 433-442.

Research output: Contribution to journalReview article

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