Nonobstructive coronary artery disease is increasingly recognized as a central cause of ischemic heart disease and major adverse events among women, differing from traditional obstructive CAD models.
This position paper highlights the paradigm shift recognizing nonobstructive CAD as a significant cause of ischemic heart disease and adverse outcomes in women, requiring specific diagnostic and management strategies.
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.
“We have focused on the obstructive lesions for over 50 years, and now what we are beginning to recognize that arteries without obstruction still can convey some obstruction to blood flow, cause ischemia and cause adverse events. It is particularly a problem in women.”
Pepine et al. (Thu,) conducted a review in Ischemic heart disease / Nonobstructive coronary artery disease. Nonobstructive coronary artery disease vs. Obstructive coronary artery disease was evaluated. Nonobstructive coronary artery disease is increasingly recognized as a central cause of ischemic heart disease and major adverse events among women, differing from traditional obstructive CAD models.