title: Evaluation of screening for myocardial ischaemia in women at cardiovascular risk.
abstract: BACKGROUND
  Cardiovascular disease is the primary cause of death in women. Prevention, screening and diagnosis are generally implemented at later stages and less frequently than in men, and provision of treatment is not optimal in women.
  
  
  OBJECTIVE
  To assess the relevance of targeted screening for myocardial ischaemia in women with multiple risk factors, and to identify which specific factors target women more effectively.
  
  
  METHODS
  We undertook a prospective observational study with retrospective data collection based on a cohort of symptomatic or asymptomatic women with multiple cardiovascular risk factors. All women underwent non-invasive diagnostic testing through the "Heart, arteries and women", healthcare pathway available at Lille University Hospital, between 1 January 2013 and 30 June 2014.
  
  
  RESULTS
  Screening was positive in 15.7% of the 287 participants. Thirty women had a coronary angiography: of these, 22 (73.3%) had no evidence of obstructive coronary artery disease. The independent predictive factors for positive screening were >5 years since menopause (odds ratio [OR] 3.9; P=0.0016); high-density lipoprotein cholesterol ≤0.5g/dL (OR 2.3; P=0.0356); and body mass index ≥30kg/m2(OR 3.7; P=0.0009). Symptoms were predictive of positive screening (P=0.010), but were mostly atypical. Based on these observations, we developed a clinical coronary score to target screening more efficiently (area under the curve 0.733). Positive screening resulted in low rates of revascularization (16.6%), but a significant increase in the prescription of statins (P=0.002), antiplatelet agents (P<0.0001) and beta-blockers (P=0.024).
  
  
  CONCLUSIONS
  Screening for myocardial ischaemia among selected women at risk of cardiovascular disease can be useful to improve medical treatment.
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France. Electronic address: anne-laure.madika@chru-lille.fr.
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Madika
authors.affiliation: Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Devos
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Delsart
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
authors.forename: Fanny
authors.initials: F
authors.lastname: Boudghène
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Polge
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Bauters
authors.affiliation: CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Mounier-Vehier
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D025401:Echocardiography, Stress; D004562:Electrocardiography; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D016015:Logistic Models; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D015999:Multivariate Analysis; D055414:Myocardial Perfusion Imaging; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011314:Preventive Health Services; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D016387:Women's Health
keywords: Coronary artery disease; Femme; Ischémie myocardique; Maladie coronaire; Myocardial ischaemia; Prevention; Prévention; Risk assessment; Women; Évaluation du risque