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The Role of Imaging in Preventive Cardiology in Women

  • Cardiac Pet, Ct, and Mri (p Cremer, Section Editor)
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A Correction to this article was published on 16 January 2023

This article has been updated

Abstract

Purpose of Review

The prevalence of CVD in women is increasing and is due to the increased prevalence of CV risk factors. Traditional CV risk assessment tools for prevention have failed to accurately determine CVD risk in women. CAC has shown to more precisely determine CV risk and is a better predictor of CV outcomes. Coronary CTA provides an opportunity to determine the presence of CAD and initiate prevention in women presenting with angina. Identifying women with INOCA due to CMD with use of cPET or cMRI with MBFR is vital in managing these patients. This review article outlines the role of imaging in preventive cardiology for women and will include the latest evidence supporting the use of these imaging tests for this purpose.

Recent Findings

CV mortality is higher in women who have more extensive CAC burden. Women have a greater prevalence of INOCA which is associated with higher MACE. INOCA is due to CMD in most cases which is associated with traditional CVD risk factors. Over half of these women are untreated or undertreated. Recent study showed that stratified medical therapy, tailored to the specific INOCA endotype, is feasible and improves angina in women.

Summary

Coronary CTA is useful in the setting of women presenting with acute chest pain to identify CAD and initiate preventive therapy. CAC confers greater relative risk for CV mortality in women versus (vs.) men. cMRI or cPET is useful to assess MBFR to diagnose CMD and is another useful imaging tool in women for CV prevention.

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  1. Department of Cardiology, Deborah Heart and Lung Center, Browns Mills, NJ, USA

    Renée P. Bullock-Palmer & Dianna Gaballa

  2. Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Erin D. Michos

  3. Cardiovascular Division (Department of Medicine), Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA

    Ron Blankstein

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Correspondence to Renée P. Bullock-Palmer.

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Renée P. Bullock-Palmer reports payment or honoraria from the American College of Cardiology Nuclear Cardiology educational product development and delivery of content and the Knowledge to Practice Webinar on the ACC AHA Chest Pain Guidelines. Renée P. Bullock-Palmer also reports being an American Heart Association – Circulation Imaging Editorial Board Member, American Society of Nuclear Cardiology Board Member, Southern NJ American Heart Association Board Member, and International Accreditation Commission CT Board Member. Erin D. Michos reports consulting fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. Ron Blankstein reports Amgen Inc. (Steering Committee Member/Research grant), Novartis Inc. (research); consulting fees from Caristo Inc. and Elucid Inc.; payment or honoraria from Siemens Inc.; and Board of Directors, Society of Cardiovascular Computed Tomography. Dianna Gaballa has no conflicts of interest.

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Bullock-Palmer, R.P., Michos, E.D., Gaballa, D. et al. The Role of Imaging in Preventive Cardiology in Women. Curr Cardiol Rep 25, 29–40 (2023). https://doi.org/10.1007/s11886-022-01828-9

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