Page 51 - Read Online

Vakhtangadze et al. Myocardial ischemia in women

By the end of the 1990s, cardiovascular morbidity in PATHOPHYSIOLOGICAL FEATURES OF
women started to drew particular attention, leading to MYOCARDIAL ISCHEMIA IN WOMEN
studies and intensive work by the world’s top cardiology
societies. At the European Society of Cardiology 2005 In general, the pathophysiological features of
conference, for example, very interesting data were myocardial ischemia differ in women and men. There
[9]
presented about the situation in Europe. It was is a significant amount of data implicating the influence
revealed that: of sex hormones on the presentation of chest pain and
• Women are underrepresented in electrocardiograph (ECG) changes.
cardiovascular research and trials.
• Women are less likely to analyze the influence In the mid-1990s, the US National Heart, Lung, and Blood
of their risk factors on morbidity and mortality rates, Institute sponsored the Women’s Ischemia Syndrome
and awareness about CVD among women is low. Evaluation (WISE) study, one of the cornerstones in the
• Women are less likely to undergo primary and evaluation of myocardial ischemia in women, [12] which
secondary prevention. assessed 936 women with chest pain. The aims of the
• Women seek medical care less often than study were to optimize the evaluation of symptoms
men. and diagnostic tests; to explore the mechanisms of
• Fewer women than men undergo diagnostic symptoms and of myocardial ischemia in the absence
tests, which results in a delay in diagnosis and a of epicardial coronary artery stenosis; and to evaluate
resulting delay in treatment. the influence of reproductive hormones on symptoms
and the results of diagnostic tests. [12-14]
Currently, the following categories of women’s
cardiovascular health are provided in modern The results of the study were published in scientific
guidelines: [10,11] papers over a long period of time. Based on these
results, four groups of women with chest pain have
High risk (at least one high-risk state): clinical been described:
manifestations of coronary heart disease, 1. Women with severe obstructive coronary
cerebrovascular disease, peripheral arterial disease, artery disease (CAD) and myocardial ischemia.
abdominal aortic aneurysm, end-stage or chronic 2. Women with obstructive CAD but without
kidney disease, diabetes, coronary heart disease with myocardial ischemia.
a 10-year risk > 10%. 3. Women without obstructive CAD but with
myocardial ischemia.
At risk (at least one risk factor from the following): 4. Women without obstructive CAD and without
tobacco consumption, arterial hypertension (systolic myocardial ischemia.
pressure > 120 mmHg, diastolic pressure > 80 mmHg, or
treatment with antihypertensive drugs), total cholesterol One of the conclusions of the WISE study: quality of life
> 200 mg/dL, high-density lipoprotein cholesterol is determined more by chest pain than by the presence
< 50 mg/dL or treatment of dyslipidemia, obesity of myocardial ischemia.
(especially central obesity), poor nutrition, low physical
activity, family history of premature CVD occurring in a Women falling into the above categories present
first-degree relative in men aged < 55 years or women daily at medical facilities with chest pain, dyspnea,
aged < 65 years, the metabolic syndrome, evidence or other symptoms, and the proper differentiation of
of subclinical atherosclerosis, poor exercise capacity any underlying conditions will determine the need
on treadmill test and/or abnormal heart rate recovery, for further investigations and the most appropriate
systemic autoimmune collagen vascular disease (e.g. treatment options. These underlying conditions
lupus, rheumatoid arthritis), history of pre-eclampsia, are macrovascular diseases, obstructive coronary
gestational diabetes, or pregnancy-induced hypertension. atherosclerosis, and microvascular disease.
Ideal cardiovascular health: total cholesterol Among the women included in the WISE study, 37%
< 200 mg/dL, arterial blood pressure < 120/80 mmHg, did not have angiographic evidence of obstructive CAD;
fasting glucose < 100 mg/dL, non-smoker, healthy diet. rather, they presented with normal or nearly normal
coronary arteries (< 20% stenosis). In 25% of women,
Raising awareness of gender-specific risk factors will non-obstructive CAD was found (at least one 20-50%
have an impact on women’s cardiovascular health. The stenosis). And in 38% of patients included in the study,
purpose of this article is to evaluate the modern views severe obstructive CAD was revealed (> 50% stenosis).
with respect to the diagnostic tools used to determine Therefore, 62% of women with angina included in the
ischemia in women. study did not have severe obstructive CAD. [12-14]

44 Vessel Plus ¦ Volume 1 ¦ June 27, 2017