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Ischemia with Non-Obstructive Coronary Artery Disease: Sex-Based Differences in Pathophysiology, Clinical
Filippo Luca Gurgoglione1, Giorgio Benatti1, Andrea Denegri1
1Division of Cardiology, Parma University Hospital, 43126 Parma, Italy.
Insights
Ischemia with non-obstructive coronary arteries (INOCA) affects quality of life. This review details sex-specific INOCA causes and outcomes, aiming for personalized treatments.
Area of Science:
- Cardiology
- Vascular Biology
- Sex-Based Medicine
Background:
- Ischemia with non-obstructive coronary arteries (INOCA) is a chronic condition with poor prognosis.
- Understanding INOCA pathophysiology has advanced through microcirculatory function assessments and spasm testing.
- Optimal management and therapeutic strategies for INOCA are still under investigation.
Purpose of the Study:
- To provide a comprehensive overview of sex-specific pathophysiological mechanisms in INOCA.
- To summarize sex-based differences in INOCA phenotype and prognosis.
- To explore current management and therapy for advancing personalized, sex-based treatment strategies.
Main Methods:
- Narrative review of existing literature.
- Analysis of sex-specific data on INOCA pathophysiology.
- Synthesis of information on INOCA phenotype, prognosis, and treatment.
Main Results:
- INOCA pathophysiology involves coronary microvascular dysfunction and vasomotor disorders.
- Significant sex-based differences exist in INOCA prevalence, phenotype, and natural history.
- Current therapeutic approaches for INOCA require further refinement for sex-specific application.
Conclusions:
- Recognizing and addressing sex-specific differences is crucial for effective INOCA management.
- Personalized treatment strategies tailored to sex are needed to improve INOCA outcomes.
- Further research into sex-based mechanisms will enhance therapeutic interventions for INOCA patients.
Abstract:
Ischemia with non-obstructive coronary arteries (INOCA) is a chronic coronary condition associated with poor prognosis and reduced quality of life. The increasing use of invasive assessments of microcirculatory function and provocative spasm testing has significantly advanced the understanding of INOCA's pathophysiology, which ranges from coronary microvascular dysfunction to vasomotor disorders. However, the optimal management and therapeutic approach for INOCA remain to be determined. Significant sex-based differences in the pathophysiology of INOCA have been reported, resulting in variations in prevalence, phenotype, and natural history between male and female patients. The aim of this narrative review is to provide a comprehensive overview of the sex-specific pathophysiological mechanisms underlying INOCA and to summarize the differences in INOCA phenotype and prognosis. Additionally, we will explore the current knowledge on management and therapy, with the goal of advancing towards sex-based personalized treatment strategies for INOCA.
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