Emergence of Nonobstructive Coronary Artery Disease A Woman's Problem and Need for Change in Definition on Angiography

• Type of Material: Article
• Authors: Carl J. Pepine, University of Florida; Keith C. Ferdinand, Tulane University; Leslee Shaw, Emory University; KellyAnn Light-McGroary, University of Iowa; Rashmee U. Shah, University of Utah; Martha Gulati, Ohio State University; Claire Duvernoy, University of Michigan; Mary Norine Walsh, St. Vincent Heart Center of Indiana; C. Noel Bairey Merz, Cedars-Sinai Heart Institute
• Language: English
• Date: 2015-10-27
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American College of Cardiology Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jacc.2015.08.876
• Title of Journal or Parent Work: Journal of the American College of Cardiology
• ISSN: 0735-1097
• Volume: 66
• Issue: 17
• Start Page: 1918
• End Page: 1933
• Grant/Funding Information: This work was supported by contracts N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164 from the National Heart, Lung and Blood Institutes; grants U0164829, U01 HL649141, U01 HL649241, K23HL105787, T32HL69751, R01 HL090957, 1R03AG032631 from the National Institute on Aging; GCRC grant MO1-RR00425 from the National Center for Research Resources; the National Center for Advancing Translational Sciences Grants UL1TR000124 and UL1TR000064; and grants from the Gustavus and Louis Pfeiffer Research Foundation, Danville, NJ; The Women's Guild of Cedars-Sinai Medical Center, Los Angeles; The Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, PA; QMED, Inc., Laurence Harbor, NJ; the Edythe L. Broad and the Constance Austin Women's Heart Research Fellowships; Cedars-Sinai Medical Center, Los Angeles; the Barbra Streisand Women's Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles; The Society for Women's Health Research (SWHR), Washington, D.C.; The Linda Joy Pollin Women's Heart Health Program; and the Erika Glazer Women's Heart Health Project, Cedars-Sinai Medical Center, Los Angeles, California.
• Keywords: COMPUTED-TOMOGRAPHY ANGIOGRAPHY; Life Sciences & Biomedicine; CARDIAC SYNDROME-X; ELEVATION MYOCARDIAL-INFARCTION; sex-specific pathophysiology; CONVERTING ENZYME-INHIBITION; Cardiac & Cardiovascular Systems; adverse outcomes; Cardiovascular System & Cardiology; L-ARGININE SUPPLEMENTATION; Science & Technology; ischemia
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology

Abstract

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.