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Stable Ischemic Heart Disease in Women

  • Kelly M. T. Schmidt
  • John Nan
  • Dawn C. Scantlebury
  • Niti R. Aggarwal
Women’s Health (M Wood, Section Editor)
  • 78 Downloads
Part of the following topical collections:
  1. Topical Collection on Women’s Health

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.

Keywords

Ischemic heart disease Women Sex differences Microvascular disease Coronary artery disease Diagnostic imaging 

Notes

Acknowledgements

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

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have 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.

References and Recommended Reading

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

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Kelly M. T. Schmidt
    • 1
  • John Nan
    • 1
  • Dawn C. Scantlebury
    • 2
  • Niti R. Aggarwal
    • 3
  1. 1.Department of MedicineUniversity of WisconsinMadisonUSA
  2. 2.Faculty of Medical SciencesUniversity of the West IndiesSt. MichaelBarbados
  3. 3.Division of Cardiovascular Medicine, Departments of Medicine and RadiologyUniversity of Wisconsin School of Medicine & Public HealthMadisonUSA

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