Prevalence, Treatment, and Control of Chest Pain Syndromes and Associated Risk Factors in Hypertensive Patients

Hendrix, Katharine H.; Mayhan, Susan; Lackland, Daniel T.; Egan, Brent M.

doi:10.1016/j.amjhyper.2005.02.016

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…Evaluation of women with symptoms suggestive of IHD is hampered by the definition of “typical” angina, derived from largely male populations where exertional components are more reflective of male patterns of presentation (85-86). Women report more angina despite lower rates of obstructive CAD (11,87-89).…”

Section: Symptom Assessment and Prevalence Of Ischemia In Womenmentioning

confidence: 99%

Women and Ischemic Heart Disease

Shaw

Bugiardini

Merz

2009

Journal of the American College of Cardiology

591

442

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Evolving knowledge regarding sex differences in coronary heart disease (CHD) is emerging. Given the lower burden of obstructive coronary artery disease (CAD) and preserved systolic function in women contrasted by higher rates of myocardial ischemia and near-term mortality compared to men, we propose the term ischemic heart disease (IHD) as appropriate for this discussion specific to women, rather than CAD or CHD. This paradoxical difference where women have lower rates of anatomical CAD but more symptoms, ischemia, and outcomes appear linked to coronary reactivity which includes microvascular dysfunction. Novel risk factors can improve the Framingham risk score, including inflammatory markers and reproductive hormones, as well as noninvasive imaging and functional capacity measurements. Risk for women with obstructive CAD is elevated compared to men, yet women are less likely to receive guideline-indicated therapies. In the setting of non-ST elevation acute myocardial infarction, interventional strategies are equally effective in biomarker positive women and men, while conservative management is indicated for biomarker negative women. For women with evidence of ischemia but no obstructive CAD, anti-anginal and anti-ischemic therapies can improve symptoms, endothelial function, and quality of life; however trials evaluating adverse outcomes are needed. We hypothesize that women experience more adverse outcomes compared to men because obstructive CAD remains the current focus of therapeutic strategies. Continued research is indicated to devise therapeutic regimens to improve symptom burden and reduce risk in women with IHD.

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Section: Symptom Assessment and Prevalence Of Ischemia In Womenmentioning

confidence: 99%

Women and Ischemic Heart Disease

Shaw

Bugiardini

Merz

2009

Journal of the American College of Cardiology

591

442

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“…Among all patients in both diagnosis groups, men received more prescriptions than women for eight of the 12 medication classes of interest-all except ARBs, CCB-Ds, CCB-NDs, and diuretics. Among hypertensive, dyslipidemic patients with angina, men received significantly more prescriptions than women for seven of the 12 16,29 Given that this was a population at risk (hypertension and dyslipidemia) and high risk (hypertension, dyslipidemia, and angina) for CV events, the finding of substantial gender and age group differences ACE=angiotensin-converting enzyme; CCB=calcium channel blocker; D=dihydropyridine; *percentage of patients receiving each, shown as 95% confidence intervals (CIs); **significant differences between CIs, p<0.05…”

Section: Resultsmentioning

confidence: 99%

Gender‐ and Age‐Related Differences in Treatment and Control of Cardiovascular Risk Factors Among High‐Risk Patients With Angina

Hendrix

Mayhan

Egan

2005

J of Clinical Hypertension

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were stratified by gender, age, and angina (n=2502) vs. nonangina (n=46,358) (angina, 43.94-43.96 vs. 34.42-34.50; nonangina, 32.43-32.43 vs. 17.25-17.25) and 100-129 mg/dL (angina, 32.12-32.14 vs. 35.10-35.18; nonangina, 53.86-53.86 vs. 32.44-32.44). More women than men had LDL-C ≥130 mg/dL (angina, 27.68-27.72 vs. 23.91-23.93; nonangina, 38.70-38.70 vs. 35.38-35.39). Women were less likely than men to receive statins (angina, 69.95-69.99 vs. 82.11-82.13; nonangina, 59.80-59.80 vs. 63.72-63.72), any antilipidemic medication at all (angina, 25.93-25.97 vs. 13.48-13.48; nonangina, 36.73-36.73 vs. 30.73-30.73), or to have current cholesterol measurements (angina, 56.82-56.88 vs. 34.54-34.56; nonangina, 45.77-45.77 vs. 39.75-39.75 C oronary heart disease (CHD) is the single leading cause of death in both men and women in the United States, accounting for more than one out of every five deaths in 2001.1 Hypertension is one of the most significant risk factors for development of CHD, affecting over half of all people who have suffered a first heart attack, and preceding development of congestive heart failure in 91% of cases. 2,3 While the health problems presented by CHD and hypertension have long been recognized in men and older patients, the magnitude of the burden of these diseases in women and younger patients has been largely overlooked until recent decades.4-6 While women do have some health advantages over men regarding the development of heart disease, these advantages are demonstrably not universal-and once CHD is manifest, women lose prognostic superiority over men. 7,8 Elevated low-density lipoprotein cholesterol (LDL-C) levels (dyslipidemia) are well documented as a major contributor to the development of atherosclerosis and subsequent coronary disease. 9Hypertensive patients with dyslipidemia are at increased risk for formation of atherosclerotic

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“…The sex of the patient may also influence treatment decisions in pain management. In contrast to the observation that female patients use more analgesics than males, it has been frequently reported that women receive less pharmacological and invasive therapies for their pain complaints . Raftery et al .…”

Section: Discussionmentioning

confidence: 98%