The Prevention, Diagnosis and Treatment of Ischemic Heart Disease in Women

  • LaPrincess C. BrewerEmail author
  • Rosalyn O. Adigun
  • Sharon L. Mulvagh


It has been almost a quarter century since the first scientific statement on cardiovascular disease in women was published, yet cardiovascular disease remains the leading cause of death in women. Women often present with atypical symptoms which delays recognition, diagnosis and treatment. The complex interplay of gaps in knowledge, sparse sex-specific outcomes data, and limitations of current guidelines lead women to suffer poorer clinical outcomes, with higher cardiovascular morbidity and mortality. While efforts to increase awareness of differences in the presentation of heart disease in women have improved our ability to evaluate women with ischemic symptoms, sex-specific differences in the pathophysiology of heart disease continue to create diagnostic and therapeutic enigmas. As our knowledge of the differential impact of traditional risk factors in women continues to grow, a paucity of sex-specific outcomes data precludes the implementation of evidence-based interventions into clinical practice. More recently, emerging data on non-traditional risk factors unique to and/or more commonly found in women is also shedding new light on the increased burden of disease among younger women, and is an area for future research and interventions. Ultimately, there remains a need for sex and evidence-based diagnostic and therapeutic strategies to address the variances in disease presentation, pharmacokinetic and pharmacodynamics differences in women compared to men, and to identify prognostic markers that can be targets for long-term monitoring. In the interim, we need to ensure that available resources for anatomic and functional assessments of cardiovascular disease are not underutilized in women. This updated review discusses the current challenges of prevention, diagnosis and treatment of ischemic heart disease in women.


Women Ischemic heart disease Coronary artery disease Cardiovascular diseases Epidemiology Disparities Cardiovascular risk Diagnosis Treatment 



American College of Cardiology


ACE inhibitors


Acute coronary syndromes


American Heart Association


Angiotensin receptor blockers


Atherosclerosis Risk in Communities


Atherosclerotic cardiovascular disease


Adult Treatment Panel


Coronary artery bypass grafting


Coronary artery calcium


Coronary artery disease


Coronary Artery Surgery Study


Coronary computed tomographic angiography


Cardiac magnetic resonance imaging


Coronary CT Angiography Evaluation for Clinical Outcomes


Cardiovascular disease


Computed tomography




Early versus Late Intervention Trial with Estradiol


Exercise treadmill test


Framingham risk score


Heart and Estrogen/Progestin Replacement Study


High-sensitivity C-reactive protein


Ischemic heart disease


Institute of Medicine


International Study of Comparative Health Effectiveness and Invasive Approaches


Kronos Early Estrogen Prevention Study


Major adverse cardiac events


Menopausal hormone therapy


Myocardial infarction


Myocardial perfusion imaging


Microvascular disease


National Cardiovascular Data Registry


National Health and Nutrition Examination Survey


National Heart Lung and Blood Institute


Pooled Cohort Equation


Percutaneous coronary intervention


Polycystic ovarian syndrome


Positron emission tomography


Peripheral reactive hyperemia index


Prospective Multicenter Imaging Study for Evaluation of Chest Pain


Rule Out Myocardial Infarction using Computer Assisted Tomography


Systematic Coronary Risk Evaluation


Single-photon emission computed tomography


Women’s Health Initiative


Women’s Ischemia Syndrome Evaluation


What is the Optimal Method for Ischemia Evaluation in Women



The authors are grateful to Mrs. Debra Ward and Mrs. Rebecca Olson for their precious assistance with chapter preparation. Dr. Brewer is supported by the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) Scholars Program (award number K12 HD065987-07) from the National Institutes of Health (NIH) Office of Research on Women’s Health (ORWH), Mayo Clinic Women’s Health Research Center.


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Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  • LaPrincess C. Brewer
    • 1
    Email author
  • Rosalyn O. Adigun
    • 2
  • Sharon L. Mulvagh
    • 1
    • 3
  1. 1.Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterUSA
  2. 2.Cardiovascular Diseases Fellow, Department of Cardiovascular MedicineMayo Clinic College of MedicineRochesterUSA
  3. 3.Division of Cardiology, Department of MedicineDalhousie University, Nova Scotia Health AuthorityHalifaxCanada

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