Editorial INOCA and MINOCA: Are Women's Heart Centres the Answer to Understanding and Management of These Increasing Populations of Women (and Men)?

• Type of Material: Article
• Authors: Christine Pacheco, Université de Montréal; Judy Luu, McGill University; Puja Mehta, Emory University; Janet Wei, Cedars-Sinai Smidt Heart Institute; Martha Gulati, Cedars-Sinai Smidt Heart Institute; Noel Bairey C Merz, Cedars-Sinai Smidt Heart Institute
• Language: English
• Date: 2022-10-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2022 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.cjca.2022.06.016
• Title of Journal or Parent Work: CANADIAN JOURNAL OF CARDIOLOGY
• Volume: 38
• Issue: 10
• Start Page: 1611
• End Page: 1614
• Grant/Funding Information: This work was supported by the National Institutes of Health R01HL124649, 1R01HL157311, and U54 AG065141, the Edythe L. Broad and the Constance Austin Women’s Heart Research Fellowships, Cedars-Sinai Medical Center, Los Angeles, California, the Barbra Streisand Women’s Cardiovascular Research and Education Program, Cedars-Sinai Medical Center, Los Angeles, The Society for Women’s Health Research, Washington, DC, the Linda Joy Pollin Women’s Heart Health Program, the Erika Glazer Women’s Heart Health Project, and the Adelson Family Foundation, Cedars-Sinai Medical Center, Los Angeles, California.
• Keywords: DIAGNOSTIC-CRITERIA; DISEASE; FAILURE; Science & Technology; Cardiac & Cardiovascular Systems; INTERNATIONAL STANDARDIZATION; ISCHEMIA; Cardiovascular System & Cardiology; Life Sciences & Biomedicine

Abstract

Cardiovascular disease (CVD) continues to be a leading cause of morbidity and mortality in women who have been underdiagnosed, undertreated, and under researched concerning prevention, diagnosis, and treatment of cardiac conditions that predominantly affect them.1 Notably, declines in CVD death rates have stalled in midlife women compared with those in men,1 suggesting sex-specific approaches might be needed. Ischemia with no obstructive coronary artery disease (INOCA) might affect up to 62% of women who undergo coronary angiography for suspected angina, with a higher prevalence in midlife women aged 45–65 years.2 The underlying pathophysiology includes coronary microvascular dysfunction (CMD), coronary endothelial dysfunction, and/or epicardial vasospasm.2 Myocardial infarction (MI) with no obstructive coronary artery disease (MINOCA), defined as evidence of clinical MI and absence of obstructive coronary artery disease (CAD; < 50% lesion), accounts for 6% of MI3 and is more frequently diagnosed in women. Common underlying causes of MINOCA include underlying plaque disruption, epicardial coronary vasospasm, occult microthrombi, or spontaneous coronary artery dissection.2 Although historically overlooked, INOCA and MINOCA are associated with adverse outcomes,2 and recent literature has contributed to increasing recognition,4 consensus on nomenclature,5,6 as well as potentially improving diagnostic workup2 and therapy.2