Coronary artery disease: clinical presentation, diagnosis and prognosis in women

Area of Science:

• Cardiovascular Medicine
• Women's Health
• Diagnostic Accuracy

Background:

• Despite advances in cardiovascular medicine, case-fatality rates for women with coronary heart disease (CHD) have not significantly declined compared to men.
• Gender-specific differences exist in symptom presentation, diagnosis, and treatment of CHD in women.
• Traditional diagnostic approaches focusing on critical stenosis often fail to identify at-risk women.

Purpose of the Study:

• To review the challenges in diagnosing and assessing risk for coronary heart disease in women.
• To evaluate the effectiveness of traditional diagnostic methods versus prognostic risk assessment for women.
• To highlight the need for gender-specific approaches in cardiovascular medicine.

Main Methods:

• Review of current evidence and literature on gender differences in coronary heart disease.
• Analysis of diagnostic challenges, including atypical symptoms and non-obstructive coronary artery disease.
• Comparison of prognostic risk assessment versus diagnostic obstructive coronary disease assessment.

Main Results:

• Atypical symptoms are common in women with obstructive CHD, complicating differential diagnosis of chest pain.
• Coronary angiography reveals non-obstructive CHD in 50% of cases, attributed to noncardiac chest pain or coronary microvascular dysfunction.
• Prognostic risk assessment appears more effective than diagnostic assessment of obstructive disease for women.

Conclusions:

• Current diagnostic strategies for CHD in women are often inadequate due to gender-specific presentations and disease patterns.
• Coronary microvascular dysfunction and noncardiac chest pain are frequent findings in women with chest pain.
• A shift towards prognostic risk assessment may improve the identification and management of cardiovascular risk in women.