Ten-Year Mortality in the WISE Study (Women's Ischemia Syndrome Evaluation)
Tanya S Kenkre1, Pankaj Malhotra2, B Delia Johnson2
1From the Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA (T.S.K., B.D.J., O.C.M., S.F.K.); Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, CA (P.M., C.N.B.M.); Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainesville (E.M.H., C.J.P.); Division of Cardiology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA (D.V.T.); Heart and Vascular Institute, University of Pittsburgh Medical Center, PA (O.C.M.); and Division of Cardiovascular Disease, School of Medicine, University of Alabama at Birmingham (W.J.R.). KenkreT@edc.pitt.edu.
Women with ischemia symptoms face significant mortality risk, with 1 in 5 dying within 9 years. Many deaths occurred without obstructive coronary artery disease, highlighting a need for new treatment guidelines.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- The Women's Ischemia Syndrome Evaluation (WISE) study prospectively followed 936 women with symptoms of ischemia undergoing coronary angiography.
- Long-term mortality data for women with ischemia symptoms are limited.
Purpose of the Study:
- To assess long-term mortality in women with symptoms of ischemia.
- To identify predictors of mortality in this cohort.
Main Methods:
- Coronary angiography defined obstructive coronary artery disease (CAD) as ≥50% stenosis.
- Mortality was assessed via National Death Index search, with deaths adjudicated as cardiovascular or noncardiovascular.
- Multivariate Cox proportional hazards regression identified mortality predictors.
Main Results:
- During a median 9.5-year follow-up, 20% of women died, with 62% of deaths being cardiovascular.
- Obstructive CAD, age, systolic blood pressure, diabetes, smoking, triglycerides, and estimated glomerular filtration rate predicted mortality.
- Notably, 31% of cardiovascular deaths occurred in women without obstructive CAD.
Conclusions:
- Approximately 1 in 5 women with ischemia symptoms died within 9 years, primarily from cardiac causes.
- Many mortality risk factors are modifiable with existing therapies.
- A significant proportion of deaths occurred in women without obstructive CAD, indicating a need for clinical trials and treatment guidance for this group.
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