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Ischemic heart disease in women: a review for primary care physicians
Anita V Kusnoor1, Angela D Ferguson, Ruth Falik
1Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA. avk1@bcm.edu
Insights
Ischemic heart disease (IHD) is a growing concern for women, with unique symptoms and causes like endothelial dysfunction. Preventive therapies like hormone replacement therapy and aspirin have proven ineffective in healthy women under 65.
Area of Science:
- Cardiology
- Women's Health
- Vascular Biology
Background:
- Ischemic heart disease (IHD) is the primary cause of mortality in Western women, with increasing prevalence.
- Pathophysiology of IHD in women differs from men, often involving endothelial dysfunction rather than critical coronary artery stenosis.
- Hypertension, intimal injury, and hyperlipidemia are key contributors to endothelial dysfunction.
Purpose of the Study:
- To explore the distinct pathophysiology and clinical presentation of IHD in women.
- To identify high-risk factors for IHD in female patients.
- To evaluate the efficacy of certain preventive therapies in women.
Main Methods:
- Review of existing literature on IHD in women.
- Analysis of differences in IHD presentation and risk factors between sexes.
- Evaluation of clinical trial data on preventive therapies.
Main Results:
- Women with chest pain and abnormal stress tests are less likely to have obstructive coronary artery disease, suggesting endothelial dysfunction as a primary mechanism.
- IHD symptoms in women often include neck and throat pain, described as sharp or burning.
- Hormone replacement therapy, antioxidants, folic acid, and aspirin were found ineffective for IHD prevention in healthy women under 65.
Conclusions:
- Endothelial dysfunction plays a significant role in IHD development in women.
- Tailored risk factor modification is crucial for managing IHD in female patients.
- Current preventive strategies like HRT, antioxidants, folic acid, and aspirin are not recommended for primary IHD prevention in healthy women under 65.
Abstract:
Ischemic heart disease (IHD) is the leading cause of death among women in the Western world, and its prevalence is growing. The pathophysiology of heart disease in women differs from that in men. Women with chest pain and abnormal stress tests are less likely than men to have critical stenosis of coronary arteries, a phenomenon attributed to endothelial dysfunction. Hypertension, intimal injury, and cholesterol are among the various factors that contribute to endothelial dysfunction. The presenting symptoms of IHD also differ in women. Women are more likely to describe neck and throat pain and to characterize the pain as intense, sharp, or burning. A history of coronary or other vascular disease, diabetes, or chronic kidney disease places patients at high risk for IHD. Risk factor modification can be tailored based on each patient's risk. Hormone replacement therapy, antioxidants, folic acid, and aspirin in healthy women under 65 years of age have recently been shown to be ineffective in the prevention of IHD.
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