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Park SM, Merz CN. Women and Ischemic Heart Disease: Recognition, Diagnosis and Management. Korean Circ J. 2016;46(4):433-42doi: 10.4070/kcj.2016.46.4.433.
Park, S. M., & Merz, C. N. (2016). Women and Ischemic Heart Disease: Recognition, Diagnosis and Management. Korean circulation journal, 46(4), 433-42. https://doi.org/10.4070/kcj.2016.46.4.433
Park, Seong-Mi, and Merz, C Noel Bairey. "Women and Ischemic Heart Disease: Recognition, Diagnosis and Management." Korean circulation journal vol. 46,4 (2016): 433-42. doi: https://doi.org/10.4070/kcj.2016.46.4.433
Park SM, Merz CN. Women and Ischemic Heart Disease: Recognition, Diagnosis and Management. Korean Circ J. 2016 Jul;46(4):433-42. doi: 10.4070/kcj.2016.46.4.433. Epub 2016 Jul 21. PMID: 27482251; PMCID: PMC4965421.
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Korean Circ J. 2016 Jul;46(4):433-42. doi: 10.4070/kcj.2016.46.4.433. Epub 2016 Jul 21.

Women and Ischemic Heart Disease: Recognition, Diagnosis and Management.

Korean circulation journal

Seong-Mi Park, C Noel Bairey Merz

Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
  2. Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

PMID: 27482251 PMCID: PMC4965421 DOI: 10.4070/kcj.2016.46.4.433

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.

Keywords: Coronary artery disease; Guideline; Microvascular angina; Myocardial ischemia; Women

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