Sex-Specific Disparities in Risk Factors for Coronary Heart Disease

  • Stacey E. RosenEmail author
  • Sonia Henry
  • Rachel Bond
  • Camille Pearte
  • Jennifer H. Mieres
Coronary Heart Disease (E Gianos and B Shah, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Coronary Heart Disease


In the past two decades, focused research on women at risk for cardiovascular disease (CVD) has helped to clarify our understanding of some of the sex-specific factors that are important in the prevention and early detection of coronary atherosclerosis with a resultant 30 % decrease in the number of women dying from CVD. In spite of these advances, CVD, specifically, ischemic heart disease due to coronary atherosclerosis is the leading cause of cardiovascular death of women in the USA. The 2010 landmark Institute of Medicine (IOM) report, “Women’s Health Research—Progress, Pitfalls and Promise,” highlighted the fact that although major progress had been made in reducing cardiovascular mortality in women, there were disparities in disease burden among subgroups of women, particularly those women who are socially disadvantaged because of race, ethnicity, income level, and educational attainment [1]. The IOM recommended targeted research on these subpopulations of women with the highest risk and burden of disease. Causes of disparities are multifactorial and are related to differences in risk factor prevalence, access to care, use of evidence-based guidelines, and social and environmental factors. In this article, we review a few of the contributing factors to the disparities in ischemic heart disease in women with a focus on the subgroups of women of Black, Latino, and South Asian descent who are at high risk for morbidity and mortality from CVD.


Cardiovascular disease in women Gender-based approach to heart disease Disparities in healthcare 


Compliance with Ethics Guidelines

Conflict of Interest

SE Rosen, S Henry, R Bond, C Pearte, and JH Mieres all declare no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Women’s Health Research: progress, pitfalls and promise. Institute of Medicine. Report Brief. September 23, 2010.Google Scholar
  2. 2.
    Mozafferin D, Benjamin EJ, Go AS et al. AHA statistical update: heart disease and stroke statistics- 2015 update. A report from American Heart Association. Circulation 2014 Dec 17: e1-e11.Google Scholar
  3. 3.
    Shaw LJ, Bugiardini R, Bainey MN. Women & ischemic heart disease. J Am Coll Cardiol. 2009;54(17):1561–75.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Wenger NK. Women and coronary heart disease: a century after Herrick: understudied, underdiagnosed and undertreated. Circulation. 2012;126:604–11.PubMedCrossRefGoogle Scholar
  5. 5.••
    Mieres JH, Gulati M, Bairey Merz N, American Heart Association Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention. Role of noninvasive testing in the clinical evaluation of women with suspected ischemic heart disease: a consensus statement from the American Heart Association. Circulation. 2014;130:350–79. This updated guideline publication includes an expanded approach to noninvasive testing highlighting new data and new techniques as well as an understanding that ischemic heart disease in women is a heterogeneous condition including both traditional obstructive coronary artery disease as well as those with other etiologies for IHD. The importance of shared decision making is also an important aspect of this publication. PubMedCrossRefGoogle Scholar
  6. 6.
    Vaccarino V. Angina and cardiac care: are there gender differences, and if so, why? Circulation. 2006;113:467–9.PubMedCrossRefGoogle Scholar
  7. 7.
    Ford ES, Ajani UA, Craft JB. Explaining the decrease in US deaths from coronary disease, 1980–2000. N Engl J Med. 2007;356:2388–98.PubMedCrossRefGoogle Scholar
  8. 8.
    Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. Jama. 1979;241(19):2035–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Huxley R, Barzi F, Woodword M. Excess risk of fatal coronary heart disease associated with diabetes mellitus in men and women: meta-analysis of 37 prospective cohort studies. BMJ. 2006;332(7533):73–8.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Anand SS, Islam S, Rosengren A, on behalf of the INTERHEART Investigators, et al. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J. 2008;29:932–40.PubMedCrossRefGoogle Scholar
  11. 11.
    Chou AF, Scholle SH, Weisman CS, Bierman AS, Correa-de-Araujo R, Mosca L. Gender disparities in the quality of cardiovascular disease care in private managed care plans. Womens Health Iss. 2007;17:120–30.CrossRefGoogle Scholar
  12. 12.
    Barett-Connor E. Why women have less heart disease than men and how diabetes modifies women’s usual cardiac protection. Global Heart. 2013;8(2):95–104.CrossRefGoogle Scholar
  13. 13.
    Roche MM, Wang PP. Sex differences in all-cause and cardiovascular mortality, hospitalization for individuals with and without diabetes, and patients with diabetes diagnosed early and late. Diabetes Care. 2013;36(9):2582–90.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Bushnell CM, Awad IA, et al. Guidelines for the prevention of stroke in women: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2014;45(5):1545–88.PubMedCrossRefGoogle Scholar
  15. 15.
    Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8:30–41.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Baillargeon JP, McClish DK, Essah PA, Nestler JE. Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab. 2005;90:3863–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Woods JW. Oral contraceptives and hypertension. Hypertension. 1988;11:II11–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Kalyani RR, Lazo M, Ouyang P, Turkbey E, Chevalier K, Brancati F, et al. Sex differences in diabetes and risk of incident coronary artery disease in healthy young and middle-aged adults. Diabetes Care. 2014;37(3):830–8.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Davidson MH, Maki KC, Karp SK, Ingram KA. Management of hypercholesterolaemia in postmenopausal women. Drugs Aging. 2002;19(3):169–78.PubMedCrossRefGoogle Scholar
  20. 20.
    Manson JE, Colditz GA, Stampfer MJ, et al. A prospective study of obesity and risk of coronary heart disease in women. N Engl J Med. 1990;322:882–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Kip KE, Marroquin OC, Kelley DE, et al. Clinical importance of obesity versus the metabolic syndrome in cardiovascular risk in women. Circulation. 2004;109:706–13.PubMedCrossRefGoogle Scholar
  22. 22.
    Broekhuizen LN, Boekholdt SM. Physical activity metabolic syndrome coronary risk: the EPIC-Norfolk prospective population study. Europ J Cardiovasc Prevent Rehabil. 2011;18(2):209–17.CrossRefGoogle Scholar
  23. 23.
    Reaven G. Metabolic syndrome: pathophysiology and implications for management of cardiovascular disease. Circulation. 2002;106:286–8.PubMedCrossRefGoogle Scholar
  24. 24.
    Beigh SH, Jain S. Prevalence of metabolic syndrome and gender differences. Bioinformation. 2012;8(13):613–6.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Hillman JK, Johnson LNC, Dokras A. Black women with polycystic ovary syndrome (PCOS) have increased risk for metabolic syndrome and cardiovascular disease compared with white women with PCOS. Fertil Steril. 2014;101(2):530–5.PubMedCrossRefGoogle Scholar
  26. 26.
    Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, et al. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS). Soc J Clin Endocrinol Metab. 2010;95:2038–49.CrossRefGoogle Scholar
  27. 27.
    Dokras A. Cardiovascular disease risk in women with PCOS. Steroids. 2013;78:773–6.PubMedCrossRefGoogle Scholar
  28. 28.
    Hu F, Grodstein F, Hennekens CH, Colditz GA, Johnson M, Manson JE, et al. Age at natural menopause and risk of cardiovascular disease. Arch Intern Med. 1999;159(10):1061–6.PubMedCrossRefGoogle Scholar
  29. 29.•
    Mosca L, Benjamin EJ, Berra K. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – update: a guideline from the American Heart Association. Circulation. 2011;123(11):1243–62. The first gender-specific guidelines for the prevention of heart disease were published in 1999, and this update includes important new flow diagrams for prevention and a new classification of CVD risk in women and also includes a discussion on disparities, cost-effectiveness, and patient education. PubMedCentralPubMedCrossRefGoogle Scholar
  30. 30.
    Robbins CL, Dietz P, Bombard J, Valderrama A. Gestational hypertension: a neglected cardiovascular disease risk marker. Am J Obstet Gynecol. 2011;204(4):336.e1–9.CrossRefGoogle Scholar
  31. 31.
    Ray JG, Vermeulen MJ, Schull MJ, Redelmeier DA. Cardiovascular health after maternal placental syndromes (CHAMPS): population based retrospective cohort study. Lancet. 2005;366:1797–803.PubMedCrossRefGoogle Scholar
  32. 32.
    Ahmed R, Dunford J, Mehran R, Robson S, Kunadian V, Pre-eclampsia and future cardiovascular risk among women. JACC 2014. Vol. 63.Google Scholar
  33. 33.
    Bruce IN, Steiner G. Risk factors for coronary heart disease in women with systemic lupus erythematosus. Toronto Risk Fact Stud Arthrit Rheumat. 2003;48(11):3159–67.CrossRefGoogle Scholar
  34. 34.
    Manzi S, Meildin EN, et al. Age specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham study. Am J Epidemiol. 1997;145(5):408–15.PubMedCrossRefGoogle Scholar
  35. 35.
    Roman MJ, Crow MK, Lockshin MD, et al. Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2007;56(10):3412–9.PubMedCrossRefGoogle Scholar
  36. 36.
    McMahon M, Hahn BH, Skaggs BJ. Systemic lupus erythematosus and cardiovascular disease: prediction and potential for therapeutic intervention. Expert Rev Clin Immunol. 2011;7(2):227–41.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Zeller CB, Appenzeller S. Cardiovascular disease in systemic lupus erythematosus: the role of traditional and lupus related risk factors. Curr Cardiol Rev. 2008;4(2):116–22.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation 123: e18–e209.Google Scholar
  39. 39.
    Wyman L et al. Depressed mood and cause-specific mortality: a 40-year general community assessment. Ann Epidemiol. 2012;22(9):638–43.PubMedCentralPubMedCrossRefGoogle Scholar
  40. 40.
    Shah AJ, Ghasemzadeh N, Vaccarino V. Sex and age differences in the association of depression with obstructive coronary artery disease and adverse cardiovascular events. J Am Heart Assoc. 2014;3:e000741. originally published June 18, 2014.PubMedCentralPubMedCrossRefGoogle Scholar
  41. 41.
    Lichtman JH, Bigger JT, Froelicher ES, et al. AHA science advisory depression and coronary heart disease: recommendations for screening, referral, and treatment. Circulation. 2008;118:1768–75.PubMedCrossRefGoogle Scholar
  42. 42.
    Vaccarino V, Shah AJ, Rooks C, Ibeanu I, Nye JA, Pimple P, et al. Sex differences in mental stress-induced myocardial ischemia in young survivors of an acute myocardial infarction. Psychosom Med. 2014;76(3):171–80.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Pedrosa RP, Barros IMLm, Costa LOBF, et al. OSA Is common and independently associated with hypertension and increased arterial stiffness in consecutive perimenopausal women, 146#1 CHEST July 2014.Google Scholar
  44. 44.
    Women’s Health Research: progress, pitfalls and promise. Institute of Medicine, Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Report Brief. September 23, 2010. obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62(7):569–57.CrossRefGoogle Scholar
  45. 45.
    Campos-Rodriguez F, Martinez-Garcia MA, Almeida-Gonzalez CV, et al. Role of sleep apnea and continuous positive airway pressure therapy in the incidence of stroke or coronary heart disease in women. Am J Respir Crit Care Med. Volume 189 Number 12 | June 15 2014,Google Scholar
  46. 46.
    Lin CM, Davidson TM, Ancoli-Israel S. Gender differences in obstructive sleep apnea and treatment implications. Sleep Med Rev. 2008;12(6):481–96.PubMedCentralPubMedCrossRefGoogle Scholar
  47. 47.
    Prather AA, Epel ES, Cohen BE, Neylan TC, Whooley MA. Gender differences in the prospective associations of self-reported sleep quality with biomarkers of systemic inflammation and coagulation: findings from the Heart and Soul Study. J Psychiatr Res 2013; 47(9):  10.1016/j.jpsychires.2013.05.004.
  48. 48.
    Miller MA, Ahuja M, Cappuccio FP. Sleep and pregnancy, sleep deprivation, sleep disturbed breathing and sleep disorders in pregnancy. Sleep, 2009: pages 1–14.Google Scholar
  49. 49.
    Mensah G, Mokdad A, et al. State of disparities in cardiovascular health in the United States. Circulation. 2005;111:1233–41.PubMedCrossRefGoogle Scholar
  50. 50.
    Go AS et al. AHA heart disease & stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129:e28–e292.PubMedCrossRefGoogle Scholar
  51. 51.
    Atherosclerosis Risk in Communities Surveillance (ARIC): 2005–2010 and Cardiovascular Health Study.Google Scholar
  52. 52.
    Gupta M, Singh N, Verma S. South Asians and cardiovascular risk: what clinicians should know. Circulation. 2006;113(25):e924–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Palaniappan L, Wang Y, Fortmann SP. Coronary heart disease mortality for six ethnic groups in California, 1990–2000. Ann Epidemiol. 2004;14(7):499–506.PubMedCrossRefGoogle Scholar
  54. 54.
    Dave TH, Wasir HS, Prabhakaran D, et al. Profile of coronary artery disease in Indian women: correlation of clinical, non invasive and coronary angiographic findings. Indian Heart J. 1991;43(1):25–9.PubMedGoogle Scholar
  55. 55.
    Gupta M, Brister S. Is South Asian ethnicity an independent cardiovascular risk factor? Can J Cardiol. 2006;22(3):193–7.PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Lewey J, Choudry NK. The current state of ethnic and racial disparities in cardiovascular care: lessons from the past and opportunities for the future. Curr Cardiol Rep. 2014;16:530.PubMedCrossRefGoogle Scholar
  57. 57.
    Gillum RF. Cardiovascular disease in the United States: an epidemiologic overview. In: Saunders E, Brest A, editors. Cardiovascular diseases in blacks. Philadelphia: F.A. Davis Company; 1991.Google Scholar
  58. 58.
    Gerhard G. Premenopausal Black women have more risk factors for coronary heart disease than white women. Am J Cardiol. 1998;82:1040–5.PubMedCrossRefGoogle Scholar
  59. 59.
    Daviglus ML, Talavera GA, et al. Prevalence of major cardiovascular risk factors and cardiovascular diseases among Hispanic/Latino individuals of diverse backgrounds in the United States. JAMA. 2012;308(17):1775–84.PubMedCentralPubMedCrossRefGoogle Scholar
  60. 60.
    Enas EA, Chacko V, Senthilkumar A, Puthumana N, Mohan V. Elevated lipoprotein(a)—a genetic risk factor for premature vascular disease in people with and without standard risk factors: a review. Dis Mon. 2006;52(1):5–50.PubMedCrossRefGoogle Scholar
  61. 61.
    Mosca L, Hammond G, et al. Fifteen-year trends in awareness of heart disease in women: results of a 2012 American Heart Association National Survey. Circulation. 2013;127:1254–63.PubMedCentralPubMedCrossRefGoogle Scholar
  62. 62.
    DeVon HA, Zerwic JJ. Symptoms of acute coronary syndromes: are there gender differences? A review of the literature. Heart Lung. 2002;31(4):235–45.PubMedCrossRefGoogle Scholar
  63. 63.
    Canto JG, Goldberg RJ, Hand MM, Bonow RO, Sopko G, Long T, et al. Symptom presentation of women with acute coronary syndromes: myth vs reality. Arch Intern Med. 2007;167(22):2405–13.PubMedCrossRefGoogle Scholar
  64. 64.
    Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813–22.PubMedCrossRefGoogle Scholar
  65. 65.
    Akhter N, Milford-Beland S, Roe MT, Piana RN, Kao J, Shroff A. Gender differences among patients with acute coronary syndromes undergoing percutaneous coronary intervention in the American College of Cardiology-National Cardiovascular Data Registry (ACC-NCDR). Am Heart J. 2009;157(1):141–8.PubMedCrossRefGoogle Scholar
  66. 66.
    Blomkalns AL, Chen AY, Hochman JS, Peterson ED, Trynosky K, Diercks DB, et al. Gender disparities in the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. JACC. 2005;45(6):832–7.PubMedCrossRefGoogle Scholar
  67. 67.
    Gupta A, Wang Y, Spertus JA, Geda M, Lorenze N, Nkonde-Price C, et al. Trends in acute myocardial infarction in young patients and differences by sex and race, 2001–2010. JACC. 2014;64(4):337–45.PubMedCrossRefGoogle Scholar
  68. 68.
    Shaw LJ, Shaw RE, Merz CN, Brindis RG, Klein LW, Nallamothu B, et al. Impact of ethnicity and gender differences on angiographic coronary artery disease prevalence and in-hospital mortality in the American College of Cardiology–National Cardiovascular Data Registry. Circulation. 2008;117:1787–801.PubMedCrossRefGoogle Scholar
  69. 69.
    Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, et al. Insights from the NHLBI-sponsored women’s Ischemia Syndrome Evaluation (WISE) study: part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease. J Am Coll Cardiol. 2006;47(suppl):S21–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Hemingway H, McCallum A, Shipley M, Manderbacka K, Martikainen P, Keskimäki I. Incidence and prognostic implications of stable angina pectoris among women and men. JAMA. 2006;295:1404–11.PubMedCrossRefGoogle Scholar
  71. 71.
    Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, Kelsey SF, et al. Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol. 2006;47(suppl):S4–S20.PubMedCrossRefGoogle Scholar
  72. 72.
    Mieres JH, Shaw LJ, Arai A, Budoff MJ, Flamm SD, Hundley WG, et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. Circulation. 2005;111:682–96.PubMedCrossRefGoogle Scholar
  73. 73.
    Cumming GR, Dufresne C, Kich L, Samm J. Exercise electrocardiogram patterns in normal women. Br Heart J. 1973;35:1055–61.PubMedCentralPubMedCrossRefGoogle Scholar
  74. 74.
    Higgins JP, Higgins JA. Electrocardiographic exercise stress testing: an update beyond the ST segment. Int J Cardiol. 2007;116:285–99.PubMedCrossRefGoogle Scholar
  75. 75.
    Morise AP, Beto R. The specificity of exercise electrocardiography in women grouped by estrogen status. Int J Cardiol. 1997;60:55–65.PubMedCrossRefGoogle Scholar
  76. 76.
    Murthy VL, Di Carli MF. Noon-invasive quantification of coronary vascular dysfunction for diagnosis and management of coronary artery disease. Jnucl Cardiol. 2012;1060.Google Scholar
  77. 77.
    O’Donoghue M, Boden WE, Braunwald E. Early invasive vs. conservative treatment strategies in women and men with unstable angina and non-ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2008;300:71–80.PubMedCrossRefGoogle Scholar
  78. 78.
    Boersma E, Harrington RA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002;359:189–98.PubMedCrossRefGoogle Scholar
  79. 79.
    Solinas E, Nikolsky E, Lansky AJ, et al. Gender-specific outcomes after sirolimus-eluting stent implantation. J Am Coll Cardiol. 2007;50:2111–6.PubMedCrossRefGoogle Scholar
  80. 80.
    Lansky AJ, Costa RA, Mooney M, et al. for the TAXUS-IV investigators. gender-based outcomes after paclitaxel-eluting stent implantation in patients with coronary artery disease. J Am Coll Cardiol. 2005;45:1180–5.PubMedCrossRefGoogle Scholar
  81. 81.
    Abramov D, Tamariz MG, Sever JY, et al. The influence of gender on the outcome of coronary artery bypass surgery. Ann Thorac Surg. 2000;70:800–5. discussion 806.PubMedCrossRefGoogle Scholar
  82. 82.
    Edwards FH, Carey JS, Grover FL, Bero JW, Hartz RS. Impact of gender on coronary bypass operative mortality. Ann Thorac Surg. 1998;66:125–31.PubMedCrossRefGoogle Scholar
  83. 83.
    Puskas JD, Edwards FH, Pappas PA, et al. Off-pump techniques benefit men and women and narrow the disparity in mortality after coronary bypass grafting. Ann Thorac Surg. 2007;84:1447–54.PubMedCrossRefGoogle Scholar
  84. 84.
    Gulati M, Cooper-DeHoff RM, McClure C, et al. Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med. 2009;169:843–50.PubMedCentralPubMedCrossRefGoogle Scholar
  85. 85.
    Lanza GA, Colonna G, Pasceri V, Maseri A. Atenolol versus amlodipine versus isosorbide-5-mononitrate on anginal symptoms in syndrome X. Am J Cardiol. 1999;84:854–6.PubMedCrossRefGoogle Scholar
  86. 86.
    Chen JW, Hsu NW, Wu TC, Lin SJ, Chang MS. Long-term angiotensin converting enzyme inhibition reduces plasma asymmetric dimethylarginine and improves endothelial nitric oxide bioavailability and coronary microvascular function in patients with syndrome X. Am J Cardiol. 2002;90:974–82.PubMedCrossRefGoogle Scholar
  87. 87.
    Manfrini O, Pizzi C, Morgagni G, Fontana F, Bugiardini R. Effect of pravastatin on myocardial perfusion after percutaneous transluminal coronary angioplasty. Am J Cardiol. 2004;93:1391–3.PubMedCrossRefGoogle Scholar
  88. 88.
    Danao_glu Z, Kültürsay H, Kayikçio_glu M, Can L, Payzin S. Effect of statin therapy added to ACE-inhibitors on blood pressure control and endothelial functions in normolipidemic hypertensive patients. Anadolu Kardiyol Derg. 2003;3:331–7.Google Scholar
  89. 89.
    Cannon 3rd RO, Quyyumi AA, Mincemoyer R, et al. Imipramine in patients with chest pain despite normal coronary angiograms. N Engl J Med. 1994;330:1411–7.PubMedCrossRefGoogle Scholar
  90. 90.
    Lerman A, Burnett Jr JC, Higano ST, McKinley LJ, Holmes Jr DR. Long-term L-arginine supplementation improves small-vessel coronary endothelial function in humans. Circulation. 1998;97:2123–8.PubMedCrossRefGoogle Scholar
  91. 91.
    Schulman SP, Becker LC, Kass DA, Gerstenblith G, et al. L-arginine therapy in acute myocardial infarction the vascular interaction with age in myocardial infarction (VINTAGE MI). JAMA. 2006;295(1):58–64.PubMedCrossRefGoogle Scholar
  92. 92.
    Mehta PK, Goykhman P, Thomson LE, et al. Ranolazine improves angina in women with evidence of myocardial ischemia but no obstructive coronary artery disease. J Am Coll Cardiol Img. 2011;4:514–22.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Stacey E. Rosen
    • 1
    Email author
  • Sonia Henry
    • 2
  • Rachel Bond
    • 2
  • Camille Pearte
    • 3
  • Jennifer H. Mieres
    • 1
  1. 1.North Shore LIJ Health SystemNew Hyde ParkUSA
  2. 2.North Shore LIJ Health SystemManhassetUSA
  3. 3.Fidelis Care New YorkRego ParkUSA

Personalised recommendations