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Sex differences in non-obstructive coronary artery disease
Nida Waheed1, Suzette Elias-Smale2, Waddah Malas3
1Department of Medicine, University of Florida, Gainesville, FL, USA.
Insights
Coronary microvascular dysfunction (CMD) causes angina in women and men, particularly those without obstructive coronary artery disease. This review highlights sex differences in CMD presentation, risk factors, diagnosis, and prognosis.
Area of Science:
- Cardiology
- Vascular Biology
- Sex Differences in Medicine
Background:
- Ischemic heart disease is a major cause of death globally.
- Women with suspected myocardial ischemia often lack obstructive coronary artery disease (CAD).
- Coronary vasomotor disorders and coronary microvascular dysfunction (CMD) are increasingly implicated in angina and adverse outcomes in non-obstructive CAD.
Purpose of the Study:
- To review sex differences in the presentation, pathophysiology, diagnostic approaches, and prognosis of coronary microvascular dysfunction (CMD).
- To emphasize the underdiagnosis of CMD despite its association with adverse cardiac events.
Main Methods:
- Literature review focusing on sex differences in CMD.
- Discussion of diagnostic modalities including coronary reactivity testing and non-invasive imaging.
- Analysis of pathophysiologic risk factors unique to women.
Main Results:
- Women with suspected ischemia are more likely to have non-obstructive CAD.
- CMD, stemming from microvascular abnormalities, contributes to cardiac events and mortality in both sexes.
- Unique female factors like inflammation, stress, and hormonal imbalances may increase susceptibility to endothelial dysfunction and CMD.
Conclusions:
- CMD is a significant contributor to ischemic symptoms, especially in women with non-obstructive CAD.
- Early detection and targeted management of CMD are crucial for improving outcomes.
- Further research into sex-specific mechanisms and treatments for CMD is warranted.
Abstract:
Ischaemic heart disease is a leading cause of morbidity and mortality in both women and men. Compared with men, symptomatic women who are suspected of having myocardial ischaemia are more likely to have no obstructive coronary artery disease (CAD) on coronary angiography. Coronary vasomotor disorders and coronary microvascular dysfunction (CMD) have been increasingly recognized as important contributors to angina and adverse outcomes in patients with no obstructive CAD. CMD from functional and structural abnormalities in the microvasculature is associated with adverse cardiac events and mortality in both sexes. Women may be particularly susceptible to vasomotor disorders and CMD due to unique factors such as inflammation, mental stress, autonomic, and neuroendocrine dysfunction, which predispose to endothelial dysfunction and CMD. CMD can be detected with coronary reactivity testing and non-invasive imaging modalities; however, it remains underdiagnosed. This review focuses on sex differences in presentation, pathophysiologic risk factors, diagnostic testing, and prognosis of CMD.
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