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Angina and Ischemia in Women with No Obstructive Coronary Artery Disease

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Gender Differences in the Pathogenesis and Management of Heart Disease

Abstract

Ischemic heart disease (IHD) continues to be a major health threat to women worldwide. Sex-specific differences in IHD presentation, pathophysiology, treatment, and outcomes have increasingly been identified. While IHD care has focused around detection and treatment of obstructive coronary artery disease (CAD), it is clear that symptomatic patients with evidence of ischemia do not always have obstructive CAD. This problem appears to disproportionately impact women; compared to men, women who present with acute coronary syndrome/unstable angina as well as stable angina are more likely to have non-obstructive CAD on coronary angiography, and yet have a high IHD morbidity and mortality. Data indicates that coronary microvascular dysfunction (CMD), due to endothelial and non-endothelial dependent mechanisms, may be an explanation in at least half of these symptomatic women who have evidence of myocardial ischemia. CMD is associated with adverse cardiovascular outcomes, including myocardial infarction, stroke, and heart failure. This chapter focuses on CMD diagnosis and treatment (pharmacological and non-pharmacological approaches) in women with no obstructive CAD.

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Acknowledgment

This work was supported by NIH grant K23HL105787.

Conflicts: Lee: none; Khambhati: none; Mehta: none.

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Authors and Affiliations

  1. J. Willis Hurst Internal Medicine Residency Program, Emory University School of Medicine, Atlanta, GA, USA

    Suegene K. Lee M.D. & Jay Khambhati M.D.

  2. Emory Women’s Heart Center, Emory University, Atlanta, GA, USA

    Puja K. Mehta M.D., F.A.C.C., F.A.H.A.

  3. Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA

    Puja K. Mehta M.D., F.A.C.C., F.A.H.A.

  4. Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA

    Puja K. Mehta M.D., F.A.C.C., F.A.H.A.

Authors
  1. Suegene K. Lee M.D.
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  2. Jay Khambhati M.D.
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  3. Puja K. Mehta M.D., F.A.C.C., F.A.H.A.
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Correspondence to Puja K. Mehta M.D., F.A.C.C., F.A.H.A. .

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Editors and Affiliations

  1. Stebbins Chair in Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Jawahar L. Mehta

  2. College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA

    Jean McSweeney

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Lee, S.K., Khambhati, J., Mehta, P.K. (2018). Angina and Ischemia in Women with No Obstructive Coronary Artery Disease. In: Mehta, J., McSweeney, J. (eds) Gender Differences in the Pathogenesis and Management of Heart Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-71135-5_8

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  • DOI: https://doi.org/10.1007/978-3-319-71135-5_8

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  • Online ISBN: 978-3-319-71135-5

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