Key result
CMD and endothelial dysfunction drive ~50% of female IHD cases, often without obstructive epicardial CAD.
Why the study?
Ischemic heart disease in women presents with unique pathophysiology and atypical clinical manifestations that challenge standard testing and diagnosis.
Highlights the unique pathophysiology of ischemic heart disease in women, emphasizing the role of microvascular disease and the need for novel diagnostic strategies beyond standard testing.
Raises awareness of sex-specific ischemic heart disease features in women; leaves open whether novel diagnostics alter outcomes.
PURPOSE: To highlight the unique pathophysiology and clinical presentation of ischemic heart disease in women. The article will emphasize the atypical clinical manifestations, reinforce the pitfalls of standard testing, and provide new insights into novel risk factors as well as diagnostic tools to enable earlier detection of disease. DATA SOURCES: An extensive review of the literature was conducted using Pub Med and CINAHL databases. The reference lists of applicable published reports were also reviewed. CONCLUSIONS: Significant evidence now exists to support the presence of coronary ischemia even in the absence of obstructive epicardial coronary occlusions. Coronary microvascular disease and/or endothelial dysfunction account for roughly 50% of heart disease cases in women. Understanding the different pathophysiologic mechanisms of coronary disease, the uncommon expression of symptoms, and the avoidance of over-reliance on standard testing to reveal disease is essential for early and accurate diagnosis. IMPLICATIONS FOR PRACTICE: A lack of awareness persists regarding the phenomenon of ischemic heart disease in women. Healthcare providers must optimize their understanding of these variations and implement strategies for early recognition and treatment. Evaluation of novel risk factors, coronary calcium screening, evaluation of endothelial function, and estimation of functional capacity offers significant advantages over traditional evaluations.
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Michelle L. Edwards (2012) conducted a review in ischemic heart disease in women. Coronary microvascular disease and/or endothelial dysfunction account for roughly 50% of ischemic heart disease cases in women, often occurring without obstructive epicardial occlusions.
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