title: Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy.
abstract: Cardiovascular disease is the leading cause of death worldwide. In the presence of signs and symptoms of myocardial ischaemia, women are more likely than men to have no obstructive coronary artery disease (CAD). Women have a greater burden of symptoms than men, and are often falsely reassured despite the presence of ischaemic heart disease because of a lack of obstructive CAD. Coronary microvascular dysfunction should be considered as an aetiology for ischaemic heart disease with signs and symptoms of myocardial ischaemia, but no obstructive CAD. Coronary microvascular dysfunction is defined as impaired coronary flow reserve owing to functional and/or structural abnormalities of the microcirculation, and is associated with an adverse cardiovascular prognosis. Therapeutic lifestyle changes as well as antiatherosclerotic and antianginal medications might be beneficial, but clinical outcome trials are needed to guide treatment. In this Review, we discuss the prevalence, presentation, diagnosis, and treatment of coronary microvascular dysfunction, with a particular emphasis on ischaemic heart disease in women.
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3600, Los Angeles, CA 90048, USA.
authors.forename: Jenna
authors.initials: J
authors.lastname: Dean
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3600, Los Angeles, CA 90048, USA.
authors.forename: Sherwin Dela
authors.initials: SD
authors.lastname: Cruz
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3600, Los Angeles, CA 90048, USA.
authors.forename: Puja K
authors.initials: PK
authors.lastname: Mehta
authors.affiliation: Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard, A3600, Los Angeles, CA 90048, USA.
authors.forename: C Noel Bairey
authors.initials: CN
authors.lastname: Merz
mesh_terms: D003324:Coronary Artery Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D003326:Coronary Circulation / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D017202:Myocardial Ischemia / Q000209:etiology; D011379:Prognosis; D012307:Risk Factors; D012737:Sex Factors