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Gender and microvascular angina

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Abstract

There are gender differences in the presentation, diagnosis, and treatment of chest pain. When compared to men, women may have more atypical presentations of chest pain. In addition, current diagnostic tools are often not definitive regarding cardiac etiology for chest pain in women. The current diagnostic model of chest pain focuses on significant obstructions within the large coronary arteries as the cause for angina. Microvascular angina (MVA) represents an under-recognized pathophysiologic mechanism that may explain the apparent disparities and elucidate an etiology for the common finding in women of chest pain, ischemia on stress testing, and no obstructive coronary artery disease (CAD) on angiography in the presence of abnormal coronary reactivity testing. Endothelial dysfunction, estrogen deficiency, and abnormal nociception play a role in the pathophysiology of MVA. Treatments are targeted toward these underlying mechanisms. Recognizing the role gender and other pathophysiologic models of chest pain can play in the work-up and treatment of angina may identify a treatable cardiac condition, that would otherwise be discounted as non-cardiac in origin.

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Acknowledgements

This work was supported by contracts from the National Heart, Lung and Blood Institutes, nos. N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164, a GCRC grant MO1-RR00425 from the National Center for Research Resources, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Denville, New Jersey, the Women’s Guild of Cedars-Sinai Medical Center, Los Angeles, California, the Edythe L. Broad Women’s Heart Research Fellowship, Cedars-Sinai Medical Center, Los Angeles, California, and the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles.

Conflict of interest statement

Noel Bairey Merz has received grant support from CV Therapeutics/Gilead. The other authors have no conflict of interest.

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  1. Women’s Heart Center, Preventive Cardiac Center, Heart Institute, Cedars-Sinai Medical Center, 444 S San Vicente Blvd, Los Angeles, California, 90048, USA

    Lynn Nugent, Puja K. Mehta & C. Noel Bairey Merz

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Nugent, L., Mehta, P.K. & Bairey Merz, C.N. Gender and microvascular angina. J Thromb Thrombolysis 31, 37–46 (2011). https://doi.org/10.1007/s11239-010-0477-1

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