Emergence of Nonobstructive Coronary Artery Disease: A Woman's Problem and Need for Change in Definition on Angiography.
Recognition of ischemic heart disease (IHD) is often delayed or deferred in women. Thus, many at risk for adverse outcomes are not provided specific diagnostic, preventive, and/or treatment strategies. This lack of recognition is related to sex-specific IHD pathophysiology that differs from traditional models using data from men with flow-limiting coronary artery disease (CAD) obstructions. Symptomatic women are less likely to have obstructive CAD than men with similar symptoms, and tend to have coronary microvascular dysfunction, plaque erosion, and thrombus formation. Emerging data document that more extensive, nonobstructive CAD involvement, hypertension, and diabetes are associated with major adverse events similar to those with obstructive CAD. A central emerging paradigm is the concept of nonobstructive CAD as a cause of IHD and related adverse outcomes among women. This position paper summarizes currently available knowledge and gaps in that knowledge, and recommends management options that could be useful until additional evidence emerges.
Division of Cardiology, University of Florida, Gainesville, Florida. Electronic address: carl.pepine@medicine.ufl.edu.
Carl J
CJ
Pepine
Tulane University School of Medicine, New Orleans, Louisiana.
Keith C
KC
Ferdinand
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
Leslee J
LJ
Shaw
Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, Iowa.
Kelly Ann
KA
Light-McGroary
Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Rashmee U
RU
Shah
The College of Medicine and The College of Clinical Public Health, The Ohio State University, Columbus, Ohio.
Martha
M
Gulati
Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan.
Claire
C
Duvernoy
St. Vincent Heart Center of Indiana, Indianapolis, Indiana.
Mary Norine
MN
Walsh
Barbra Streisand Women's Heart Center, Cedars-Sinai Heart Institute, Los Angeles, California.
C Noel
CN
Bairey Merz
D054058:Acute Coronary Syndrome / Q000473:pathology / Q000503:physiopathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000628:therapy; D003331:Coronary Vessels / Q000473:pathology / Q000503:physiopathology; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003925:Diabetic Angiopathies / Q000503:physiopathology; D004730:Endothelium, Vascular / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology; D016387:Women's Health
adverse outcomes; ischemia; sex-specific pathophysiology