Managing Ischemic Heart Disease in Women: Role of a Women’s Heart Center

Khandelwal, Abha; Bakir, May; Bezaire, Meghan; Costello, Briana; Gomez, Joanne Michelle D.; Hoover, Valerie; Nazir, Noreen; Nichols, Katherine M.; Reisenberg, Amy; Rao, Anupama; Sanghani, Rupa; Tracy, Melissa; Volgman, Annabelle Santos

doi:10.1007/s11883-021-00956-x

Cited by 18 publications

(18 citation statements)

References 118 publications

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“…Ischaemic heart disease (IHD), manifested as a myocardial infarction (MI), represents the leading cause of death in women [ 124 ]. In patients under the age of 55, the association of hypertension, depression, diabetes, current smoking, a family history of diabetes, and younger age is stronger for MI in women than men [ 125 ].…”

Section: Sex Dimorphism and Obesity-related Cardiovascular Abnormalitiesmentioning

confidence: 99%

Sex Differences in Adiposity and Cardiovascular Diseases

Konja

Wang

et al. 2022

IJMS

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Body fat distribution is a well-established predictor of adverse medical outcomes, independent of overall adiposity. Studying body fat distribution sheds insights into the causes of obesity and provides valuable information about the development of various comorbidities. Compared to total adiposity, body fat distribution is more closely associated with risks of cardiovascular diseases. The present review specifically focuses on the sexual dimorphism in body fat distribution, the biological clues, as well as the genetic traits that are distinct from overall obesity. Understanding the sex determinations on body fat distribution and adiposity will aid in the improvement of the prevention and treatment of cardiovascular diseases (CVD).

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Section: Sex Dimorphism and Obesity-related Cardiovascular Abnormalitiesmentioning

confidence: 99%

Sex Differences in Adiposity and Cardiovascular Diseases

Konja

Wang

et al. 2022

IJMS

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“… 38 , 39 This level of non-persistence is problematic as pharmacological treatment reduces risk of MACE, also in females who more often suffer from a non-obstructive coronary artery disease that causes a different ischemic endothelial damage profile compared to men. 16 …”

Section: Discussionmentioning

confidence: 99%

“… 14 , 15 Further, any delay in secondary pharmacological treatment will increase risk of MACE, also in females who more often suffer from non-obstructive coronary artery disease. 16 …”

Section: Introductionmentioning

confidence: 99%

Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study

Graversen¹,

Valentin²,

Larsen³

et al. 2021

CLEP

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“…[1][2][3][4] This phenomenon has come to be known as the "gender paradox" and may lead to misdiagnosis and poorer outcome in women. [5][6][7] Importantly, in both women and men, coronary artery disease accounts for a similar and high proportion of all cause death in western doi: 10.1136/bmj-2022-071133 | BMJ 2022;379:e071133 | the bmj countries. [8][9][10] Nevertheless, the paucity of diagnostic and management trials specifically randomising either women or men and predefining such subgroups as targets for analysis in terms of outcomes precludes informed clinical recommendations.…”

Section: Introductionmentioning

confidence: 99%

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

2022

BMJ

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Objective To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease. Design Prospective, multicentre, randomised pragmatic trial. Setting Hospitals at 26 sites in 16 European countries. Participants 2002 (56.2%) women and 1559 (43.8%) men (total of 3561 patients) with suspected coronary artery disease referred for invasive coronary angiography on the basis of stable chest pain and a pre-test probability of obstructive coronary artery disease of 10-60%. Intervention Both women and men were randomised 1:1 (with stratification by gender and centre) to a strategy of either computed tomography or invasive coronary angiography as the initial diagnostic test (1019 and 983 women, and 789 and 770 men, respectively), and an intention-to-treat analysis was performed. Randomised allocation could not be blinded, but outcomes were assessed by investigators blinded to randomisation group. Main outcome measures The primary endpoint was major adverse cardiovascular events (MACE; cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke). Key secondary endpoints were an expanded MACE composite (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, transient ischaemic attack, or major procedure related complication) and major procedure related complications. Results Follow-up at a median of 3.5 years was available in 98.9% (1979/2002) of women and in 99.0% (1544/1559) of men. No statistically significant gender interaction was found for MACE (P=0.29), the expanded MACE composite (P=0.45), or major procedure related complications (P=0.11). In both genders, the rate of MACE did not differ between the computed tomography and invasive coronary angiography groups. In men, the expanded MACE composite endpoint occurred less frequently in the computed tomography group than in the invasive coronary angiography group (22 (2.8%) v 41 (5.3%); hazard ratio 0.52, 95% confidence interval 0.31 to 0.87). In women, the risk of having a major procedure related complication was lower in the computed tomography group than in the invasive coronary angiography group (3 (0.3%) v 21 (2.1%); hazard ratio 0.14, 0.04 to 0.46). Conclusion This study found no evidence for a difference between women and men in the benefit of using computed tomography rather than invasive coronary angiography as the initial diagnostic test for the management of stable chest pain in patients with an intermediate pre-test probability of coronary artery disease. An initial computed tomography scan was associated with fewer major procedure related complications in women and a lower frequency of the expanded MACE composite in men. Trial registration NCT02400229ClinicalTrials.gov NCT02400229 .

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Managing Ischemic Heart Disease in Women: Role of a Women’s Heart Center

Cited by 18 publications

References 118 publications

Sex Differences in Adiposity and Cardiovascular Diseases

Sex Differences in Adiposity and Cardiovascular Diseases

Non-Persistence with Medication as a Mediator for the Social Inequality in Risk of Major Adverse Cardiovascular Events in Patients with Incident Acute Coronary Syndrome: A Nationwide Cohort Study

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

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