Non-atherosclerotic coronary causes of myocardial infarction in women
Abhishek Chaturvedi1, Naga Vaishnavi Gadela2, Kriti Kalra3
1Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States.
Insights
Myocardial infarction (MI) in women often stems from non-atherosclerotic causes, unlike men. Recognizing these diverse mechanisms is crucial for accurate diagnosis and treatment, as women are disproportionately affected.
Area of Science:
- Cardiology
- Women's Health
- Pathophysiology
Background:
- Ischemic heart disease is a leading cause of death in women globally.
- While obstructive coronary atherosclerosis is common, non-atherosclerotic causes of myocardial infarction (MI) are increasingly recognized.
- Women experience MI without atherosclerosis more frequently than men, yet remain underdiagnosed and undertreated.
Purpose of the Study:
- To review non-atherosclerotic coronary causes of MI.
- To focus on evidence specific to women.
- To provide a foundation for future research.
Main Methods:
- Literature review of existing studies.
- Focus on non-atherosclerotic mechanisms of MI.
- Emphasis on data pertaining to women.
Main Results:
- Non-atherosclerotic MI mechanisms include spontaneous coronary artery dissection, vasospasm, microvascular dysfunction, and others.
- Women are 2-5 times more likely to have MI without atherosclerosis compared to men.
- Advancements in imaging and physiological testing aid in diagnosis and treatment.
Conclusions:
- Non-atherosclerotic MI is a significant concern in women.
- Improved understanding and diagnostic tools are essential for better outcomes.
- Further research is needed to address diagnosis and treatment disparities.
Abstract:
Ischemic heart disease is the most common cardiovascular cause of death in women worldwide. Obstructive coronary atherosclerosis is the primary cause of myocardial infarction (MI), however, non-atherosclerotic mechanisms of MI, such as spontaneous coronary artery dissection, vasospasm, microvascular dysfunction, embolization, inflammation, coronary anomalies, infectious and infiltrative causes are increasingly being recognized. Emerging data suggest that women are two to five times more likely to have an MI in the absence of coronary atherosclerosis compared to men, but they continue to remain underdiagnosed and undertreated, partly due to underdiagnosis and limited understanding of these mechanisms. Recent advancements in invasive and noninvasive imaging techniques and physiological testing allow for distinguishing these mechanisms from each other, providing a definitive diagnosis and tailored treatment. This review summarizes the existing literature on the non-atherosclerotic coronary causes of MI with a focus on evidence pertaining to women, offering a basis for future studies.
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