Background The Women’s Ischemia Syndrome Evaluation (WISE) was a prospective cohort study of 936 clinically stable symptomatic women who underwent coronary angiography to evaluate symptoms and signs of ischemia. Long-term mortality data for such women are limited. Methods and Results Obstructive coronary artery disease (CAD) was defined as ≥50% stenosis on angiography by core lab. We conducted a National Death Index search to assess the mortality of women who were alive at their final WISE contact date. Death certificates were obtained. All deaths were adjudicated as cardiovascular (CV) or non-CV by a panel of WISE cardiologists masked to angiographic data. Multivariate Cox proportional hazards regression was used to identify significant independent predictors of mortality. At baseline, mean age was 58±12 years; 176 (19%) were non-white, primarily African American; 25% had a history of diabetes, 59% hypertension, 55% dyslipidemia, and 59% had a body mass index (BMI) ≥30. Over a median follow-up of 9.5 years (range 0.2 to 11.5 years) a total of 184 (20%) died. Of these, 115 (62%) were CV deaths; 31% of all CV deaths occurred in women without obstructive CAD (<50% stenosis). Independent predictors of mortality were obstructive CAD, age, baseline systolic blood pressure, history of diabetes, history of smoking, elevated triglycerides and estimated glomerular filtration rate. Conclusions Among women referred for coronary angiography for signs and symptoms of ischemia one in five died from predominantly cardiac etiologies within 9 years of angiographic evaluation. A majority of the factors contributing to the risk of death appear to be modifiable by existing therapies. Of note, one in three of the deaths in this cohort occurred in women without obstructive CAD, a condition often considered benign and without guideline-recommend treatments. Clinical trials are needed to provide treatment guidance for the group without obstructive CAD.

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Objective Studies have linked vasomotor symptoms to markers of cardiovascular disease risk, yet few have considered clinical cardiovascular events. Data suggest that associations may depend upon the age that symptoms occur. We examined associations between vasomotor symptoms and cardiovascular events and endothelial function, considering age of symptom onset. Methods The Women’s Ischemia Syndrome Evaluation enrolled women referred for coronary angiography for suspected myocardial ischemia. 254 women aged >50 years, postmenopausal, with both ovaries, not taking hormone therapy underwent a baseline evaluation, were followed annually (median=6.0 years), and the National Death Index was searched to ascertain cardiovascular disease mortality (median=9.3 years). A subset of participants underwent brachial artery ultrasound for flow mediated dilation. Receiver operating curve analysis was used to determine vasomotor symptom groups [symptoms beginning

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