Women and Ischemic Heart Disease: Recognition, Diagnosis and Management
Seong-Mi Park1, C Noel Bairey Merz2
1Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Insights
Women experience more severe ischemic heart disease (IHD) symptoms and functional disability than men. Addressing these gender gaps requires improved testing and guideline-based therapies for better outcomes in female patients.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Women's Health
Background:
- Cardiovascular disease is a leading global cause of death for both sexes.
- Women present with a higher symptom burden and functional disability in myocardial ischemia.
- Nonobstructive coronary artery disease (CAD) and coronary microvascular dysfunction are more prevalent in women, contributing to sex-specific pathophysiology.
Purpose of the Study:
- To highlight the unique aspects of ischemic heart disease (IHD) in women, advocating for the term IHD over CAD for female-specific discussions.
- To review the progress and persistent gender disparities in cardiovascular mortality and clinical outcomes for women.
- To emphasize the need for guideline adherence in diagnostic testing and evidence-based therapies for women with IHD.
Main Methods:
- Review of existing literature and guideline campaigns (e.g., National Heart, Lung, and Blood Institute Heart Truth, Women's Ischemia Syndrome Evaluation).
- Analysis of sex differences in symptom presentation, diagnostic testing utilization, and therapeutic interventions for myocardial ischemia.
- Evaluation of the effectiveness of anti-anginal and anti-atherosclerotic strategies in women with ischemia and nonobstructive CAD.
Main Results:
- Despite decreased cardiovascular mortality in women, significant gender gaps in clinical outcomes persist.
- Women are less likely to undergo recommended diagnostic testing for myocardial ischemia, even when at high risk.
- Suboptimal use of guideline-recommended therapies is observed in women compared to men.
- Anti-anginal and anti-atherosclerotic strategies show efficacy for symptom and ischemia management in women with nonobstructive CAD.
Conclusions:
- The term ischemic heart disease (IHD) is more appropriate for discussing cardiovascular issues specific to women.
- Improved adherence to diagnostic guidelines and evidence-based therapies, such as the simplified ABC approach, is crucial for managing IHD in women.
- Further female-specific research is needed to optimize the treatment and outcomes for women with cardiovascular disease, particularly those with nonobstructive CAD.
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, angiotensin-converting enzyme inhibitors/angiotensin-renin blockers, beta blockers, cholesterol management and statin) should be used and can help to increases adherence to guidelines.
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