Clinical presentation of CAD and myocardial ischemia in women

doi:10.1007/s12350-016-0593-1

Journal of Nuclear Cardiology

Volume 23, Issue 5, October 2016, Pages 976-985

https://doi.org/10.1007/s12350-016-0593-1 Get rights and content

Abstract

Angina is the most frequent initial and subsequent manifestation of ischemic heart disease in women. Women with stable ischemic heart disease have a more diverse symptom presentation than men, with prominent anginal equivalents; symptoms are more often precipitated by emotional or mental stress. Women, especially at younger age, whose acute myocardial infarction presentation is without chest pain have higher mortality rates than men without chest pain.

Section snippets

Stable Ischemic Heart Disease

Angina is the most frequent initial and subsequent manifestation of coronary heart disease and myocardial ischemia in women and contributes both to the clinical and economic burden of cardiovascular disease. Women with stable ischemic heart disease, however, have a more diverse symptom presentation than do men, with pain or discomfort not only in the chest but in the arms, jaw, neck, and interscapular area; associated epigastric discomfort and associated nausea, and have a different pattern of

Acute Coronary Syndrome

Sex differences are equally evident in the clinical presentation of patients with acute coronary syndrome as well.11, 12, 13 Although central chest pain or discomfort is the most frequent presentation, women often evidence atypical chest pain radiations and angina equivalent symptoms such as dyspnea, weakness, fatigue, and indigestion, similar to the sex-differing presentations encountered in stable ischemic heart disease (Table 2).

Pain in the back, arm, neck, and shoulder, as well as unusual

References (17)

Bairey MerzCN et al.
Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease
J Am Coll Cardiol.
(2006)
ShawLJ et al.
Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies
J Am Coll Cardiol.
(2006)
ShawLJ et al.
Women and ischemic heart disease: evolving knowledge
J Am Coll Cardiol.
(2009)
PepineCJ et al.
Emergence of nonobstructive coronary artery disease: a woman’s problem and need for change in definition on angiography
J Am Coll Cardiol
(2015)
MoscaL et al.
Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes
Circulation
(2011)
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the...
MoscaL et al.
Evidence-based guidelines for cardiovascular disease prevention in women
Circulation
(2004)
MieresJH et al.
Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association
Circulation
(2005)

There are more references available in the full text version of this article.

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Cardiovascular Imaging in Women
2024, Seminars in Nuclear Medicine
Multimodality cardiovascular imaging is a cornerstone diagnostic tool in the diagnosis, risk stratification, and management of cardiovascular diseases, whether those involving the coronary tree, myocardial, or pericardial diseases in general and particularly in women. This manuscript aims to shed some light and summarize the very features of cardiovascular disease in women, explore their unique characteristics and discuss the role of cardiovascular imaging in ischemic heart disease and cardiomyopathies. The role of four imaging modalities will be discussed including nuclear medicine, echocardiography, noninvasive coronary angiography, and cardiac magnetic resonance.
Self-Management Interventions for Women With Cardiac Pain: A Systematic Review and Meta-analysis
2018, Canadian Journal of Cardiology
Cardiac pain is considered the primary indicator of coronary artery disease (CAD). Existing reviews lack appropriate numbers of women or sex-based subgroup analyses, or both; thus, the benefits of self-management (women with cardiac pain actively participating in their own care and treatment) remain uncertain.
Using methods described by the Evidence for Policy and Practice Information and Co-ordinating Centre at the Institute of Education, 7 databases were systematically searched to examine and synthesize the evidence on self-management interventions for women with cardiac pain and cardiac pain equivalents, such as fatigue, dyspnea, and exhaustion.
Our search yielded 22,402 article titles and abstracts. Of these, 57 randomized controlled trials were included in a final narrative synthesis, comprising data from 13,047 participants, including 5299 (41%) women. Self-management interventions targeting cardiac pain in women compared with a control population reduced (1) cardiac pain frequency and cardiac pain proportion (obstructive and nonobstructive CAD), (2) fatigue at 12 months, and (3) dyspnea at 2 months. There was no evidence of group differences in postprocedural (percutaneous coronary intervention or cardiac surgery) pain. Results indicated that self-management interventions for cardiac pain were more effective if they included a greater proportion of women (standardized mean difference [SMD], −0.01; standard error, 0.003; P = 0.02), goal setting (SMD, −0.26; 95% confidence interval [CI], −0.49 to −0.03), and collaboration/support from health care providers (SMD, −0.57; 95% CI, −1.00 to −0.14).
The results of this review suggest that self-management interventions reduce cardiac pain and cardiac pain equivalents.
La douleur d’origine cardiaque est considérée comme le principal indicateur de la coronaropathie. Les revues existantes disposent d’un nombre insuffisant de femmes ou d’analyses en sous-groupes fondées sur le sexe, ou les deux. Par conséquent, les avantages de la prise en charge autonome (les femmes ayant des douleurs d’origine cardiaque qui participent activement à leurs propres soins et au traitement) demeurent incertains.
À l’aide des méthodes décrites dans l’Evidence for Policy and Practice Information and Co-ordinating Centre (Centre d’information et de coordination de la politique et la pratique fondées sur des preuves), nous avons fouillé de manière systématique 7 banques de données pour examiner et faire la synthèse des données probantes sur les interventions en matière de prise en charge autonome chez les femmes ayant des douleurs d’origine cardiaque et des équivalents de la douleur d’origine cardiaque, comme la fatigue, la dyspnée et l’épuisement.
Notre recherche a permis d’obtenir 22 402 titres d’articles et résumés. Parmi ceux-ci, nous avons inclus 57 essais cliniques à répartition aléatoire à la synthèse narrative finale, qui était constituée des données de 13 047 participants, dont celles de 5299 (41 %) femmes. Les interventions en matière de prise en charge autonome qui visaient la douleur d’origine cardiaque chez les femmes par rapport à la population témoin ont favorisé la réduction de : 1) la fréquence de la douleur d’origine cardiaque et la proportion de douleurs cardiaques (coronaropathies obstructives et non obstructives); 2) la fatigue après 12 mois; 3) la dyspnée après 2 mois. Il n’existait aucune donnée probante sur les différences entre les groupes en ce qui concerne la douleur après les interventions (intervention coronarienne percutanée ou chirurgie cardiaque). Les résultats ont montré que les interventions en matière de prise en charge autonome de la douleur d’origine cardiaque étaient plus efficaces si elles comportaient une plus grande proportion de femmes (différence moyenne standardisée [DMS], −0,01 ; erreur type, 0,003 ; P = 0,02), la quantification des objectifs (DMS, −0,26 ; intervalle de confiance [IC] à 95 %, −0,49 à −0,03), et la collaboration et le soutien des fournisseurs de soins de santé (DMS, −0,57 ; IC à 95 %, −1,00 à −0,14).
Les résultats de cette revue montrent que les interventions en matière de prise en charge autonome favorisent la réduction de la douleur d’origine cardiaque et des équivalents de la douleur d’origine cardiaque.
Gender difference in cardiovascular outcomes with SGLT-2 inhibitors and GLP-1 receptor agonist in type 2 diabetes: A systematic review and meta-analysis of cardio-vascular outcome trials
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Type 2 diabetes confers a differential risk of cardiovascular (CV) disease according to the gender. Whether newly approved anti-diabetic drugs like sodium-glucose co-transport-2 inhibitors (SGLT-2Is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs) that have shown a significant reduction in the CV end-points in CV outcome trials (CVOTs) also have a differential impact gender-wise, is still not clearly known.
We systematically searched the medical database up to December 31, 2019 and retrieved all the dedicated CVOTs conducted with SGLT-2Is and GLP-1RAs that explicitly reported the outcome of major adverse cardiac events (MACE). Subsequently, we pooled the hazard ratio (HR) of MACE in both sexes separately and meta-analyzed the result gender-wise.
The meta-analysis of three CVOTs conducted with SGLT-2Is (N = 34,322), demonstrated a significant reduction in MACE in men but not in women (Men - HR, 0.90; 95% CI, 0.83 to 0.97; P = 0.006; Women - HR, 0.88; 95% CI, 0.77 to 1.00; P = 0.06) compared to placebo. The meta-analysis of seven CVOTs conducted with GLP-1RAs (N = 56,004) demonstrated a significant reduction in MACE in both sex (Men - HR, 0.88; 95% CI, 0.82 to 0.93; P < 0.0001; Women - HR, 0.88; 95% CI, 0.79 to 0.99; P = 0.03), against the placebo.
The reduction in MACE with SGLT-2Is appears to be significantly less in women with diabetes vs men, while GLP-1RAs confers a similar reduction in MACE, irrespective of the gender. Whether these results are related to inadequate statistical power (underrepresentation of women) in CVOT, or it reflects a true gender difference, still remains to be established.
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Nomogram to predict recurrent chest pain in patients with myocardial bridging
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Review ArticleClinical presentation of CAD and myocardial ischemia in women

Abstract

Section snippets

Stable Ischemic Heart Disease

Acute Coronary Syndrome

J Am Coll Cardiol.

J Am Coll Cardiol.

J Am Coll Cardiol.

J Am Coll Cardiol

Sex/gender differences in cardiovascular disease prevention: what a difference a decade makes

Circulation

Evidence-based guidelines for cardiovascular disease prevention in women

Circulation

Circulation

Review Article
Clinical presentation of CAD and myocardial ischemia in women