title: Patterns and behavior of transient myocardial ischemia in stable coronary disease are the same in both men and women: a comparative study.
abstract: OBJECTIVE
  This study sought to compare the circadian variations in transient ischemic activity, mean heart rate and ischemic threshold between women and men with coronary artery disease.
  
  
  BACKGROUND
  There is a circadian variation in ischemic activity, onset of myocardial infarction and sudden cardiac death in patients with coronary artery disease, but studies assessing ischemia have incorporated predominantly male subjects.
  
  
  METHODS
  Thirty-one women and 45 men underwent at least 48 h of ambulatory ST segment monitoring.
  
  
  RESULTS
  There was a similar and significant circadian variation in ischemic activity in both women and men (p < 0.0001 and p < 0.0001, respectively), with a trough at night, a surge in the morning and a peak between 1 and 2 PM, corresponding to a similar circadian variation in mean hourly heart rate (p < 0.0001) that was not different between men and women (p = 0.28, power to detect a shift 99.9%). Mean heart rate at onset of ischemia (ischemic threshold) had similar variability in women and men (p = 0.96), and harmonic regression analysis confirmed a significant circadian variation (p < 0.0001), with a trough at night and a peak during activity hours. Heart rate increased significantly in the 5 min before ischemia throughout the 24 h (p < 0.0001), with no gender differences in the pattern of preonset to onset heart rate changes over time (p = 0.52); the smallest differences were recorded in the middle of the night. The majority of ischemic episodes (80%) had a heart rate increase > 5 beats/min in the 5 min before ischemia, but there were no gender differences.
  
  
  CONCLUSIONS
  Women with coronary artery disease have a pattern of ischemic activity and underlying pathophysiologic mechanisms very similar to men. The importance of increase in myocardial oxygen demand in the genesis of ischemia in both men and women is reflected by similar magnitude of heart rate increases before ischemia. The lower ischemic threshold during the nocturnal hours, when blood pressure is also lower, is consistent with a circadian variation in underlying coronary vascular tone.
authors.affiliation: Cardiology Branch of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
authors.forename: D
authors.initials: D
authors.lastname: Mulcahy
authors.forename: N
authors.initials: N
authors.lastname: Dakak
authors.forename: G
authors.initials: G
authors.lastname: Zalos
authors.forename: N P
authors.initials: NP
authors.lastname: Andrews
authors.forename: M
authors.initials: M
authors.lastname: Proschan
authors.forename: M A
authors.initials: MA
authors.lastname: Waclawiw
authors.forename: W H
authors.initials: WH
authors.lastname: Schenke
authors.forename: A A
authors.initials: AA
authors.lastname: Quyyumi
mesh_terms: D000208:Acute Disease; D002940:Circadian Rhythm; D003327:Coronary Disease / Q000503:physiopathology*; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology*; D012727:Sex Characteristics