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Emergence of Nonobstructive Coronary Artery Disease: A Woman's Problem and Need for Change in Definition on
Carl J Pepine1, Keith C Ferdinand2, Leslee J Shaw3
1Division of Cardiology, University of Florida, Gainesville, Florida.
Insights
Delayed recognition of ischemic heart disease (IHD) in women hinders timely care. Understanding sex-specific IHD pathophysiology, including nonobstructive coronary artery disease (CAD), is crucial for improving diagnosis and treatment.
Area of Science:
- Cardiology
- Women's Health
- Pathophysiology
Background:
- Ischemic heart disease (IHD) recognition is often delayed in women.
- This delay is linked to sex-specific IHD pathophysiology differing from traditional male-centric models.
- Women with symptoms are less likely to have obstructive coronary artery disease (CAD).
Purpose of the Study:
- To summarize current knowledge on IHD in women, focusing on nonobstructive CAD.
- To identify knowledge gaps in IHD diagnosis and management for women.
- To recommend management strategies pending further evidence.
Main Methods:
- Literature review and synthesis of emerging data.
- Analysis of sex-specific IHD pathophysiology.
- Position paper development.
Main Results:
- Women often present with nonobstructive CAD, coronary microvascular dysfunction, plaque erosion, and thrombus formation.
- Nonobstructive CAD, hypertension, and diabetes are associated with adverse events similar to obstructive CAD.
- A paradigm shift is needed to consider nonobstructive CAD as a cause of IHD in women.
Conclusions:
- Current IHD models based on men are insufficient for women.
- Nonobstructive CAD is an emerging cause of IHD and adverse outcomes in women.
- Revised diagnostic and treatment strategies are needed for women with IHD.
Abstract:
Recognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.
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