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Stable Ischemic Heart Disease in Women

  • Women’s Health (M Wood, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Abstract

Purpose of the review

Paradoxically, although women have a lower burden of coronary atherosclerosis, they experience more symptoms, more frequent hospitalizations, and a worse prognosis compared to men. This is in part due to biological variations in pathophysiology between the two sexes, and in part related to inadequate understanding of these differences, subconscious referral bias, and suboptimal application of existing women-specific guidelines. We sought to review the contemporary literature and provide an update on risk assessment, diagnosis, and management of IHD in women.

Recent findings

IHD in women is often secondary to diffuse non-obstructive atherosclerosis, coronary spasm, inflammation, and endothelial and microvascular dysfunction, and less commonly due to the male pattern of flow-limiting epicardial stenosis. Both IHD patterns likely represent sex-specific manifestations of the same disease process. Additionally, there is a differential expression of risk factors and symptoms between men and women. Application of male-pattern IHD risk factors and presentation to women contributes to under-recognition, under-testing, and under-treatment of IHD in women compared to men. Traditional diagnostic evaluation has focused on detection of epicardial disease, amenable to revascularization. Our improved understanding of sex-specific pathophysiology of IHD has enabled us to also develop tools for detection of microvascular disease. Advances in stress MRI, flow quantification on stress PET, and provocative invasive angiography have filled this void and offer important diagnostic and prognostic information.

Summary

Despite our improved understanding of sex-specific differences in presentation, risk factors, pathophysiology, diagnostic testing, and management strategies of IHD, women with IHD continue to experience worse outcomes than men. This disparity underscores the need for improved research and understanding of biological sex differences, elimination of subconscious gender bias in referral patterns, and improved application of existing research into clinical practice.

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Acknowledgements

The authors wish to thank Mr. Guy Bolling for his editorial assistance.

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Authors and Affiliations

  1. Department of Medicine, University of Wisconsin, Madison, WI, USA

    Kelly M. T. Schmidt MD & John Nan MD

  2. Faculty of Medical Sciences, University of the West Indies, Cave Hill Campus, St. Michael, Barbados

    Dawn C. Scantlebury MBBS, FACC

  3. Division of Cardiovascular Medicine, Departments of Medicine and Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Avenue, Madison, WI, 53792-3248, USA

    Niti R. Aggarwal MD, FACC

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  1. Kelly M. T. Schmidt MD
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  3. Dawn C. Scantlebury MBBS, FACC
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  4. Niti R. Aggarwal MD, FACC
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Correspondence to Niti R. Aggarwal MD, FACC.

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Schmidt, K.M.T., Nan, J., Scantlebury, D.C. et al. Stable Ischemic Heart Disease in Women. Curr Treat Options Cardio Med 20, 72 (2018). https://doi.org/10.1007/s11936-018-0665-4

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