What Is the Role of Assessing Ischemia to Optimize Therapy and Outcomes for Patients with Stable Angina and Non-obstructed Coronary Arteries?

Berry, Colin; Morrow, Andrew; Marzilli, Mario; Pepine, Carl J.

doi:10.1007/s10557-021-07179-x

“…MPS is the most specific of the non-invasive options for myocardial ischemia [ 45 ]. However, in women, accuracy is lower due to smaller heart size and higher left ventricular ejection fraction, and is less frequently the first investigation of choice in women due to increased radiation exposure [ 46 ].…”

Section: Diagnosing Ischemic Heart Disease In Womenmentioning

confidence: 99%

Reappraising Ischemic Heart Disease in Women

Carberry¹,

Aubiniere-Robb²,

Kamdar³

et al. 2023

Rev. Cardiovasc. Med.

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Despite advances in the management of ischemic heart disease worldwide, mortality in women remains disproportionally high in comparison to men, particularly in women under the age of 55. The greater prevalence of ischemia with non-obstructive coronary arteries (INOCA) in women has been highlighted as a potential cause of this disparity. Moreover, current guideline recommendations for computed tomography coronary angiography (CTCA) as the first line of investigation for stable chest pain may further amplify this inequality. Traditional cardiovascular risk factors carry greater influence in women than men in the development of ischemic heart disease. Despite this, women have been consistently under-represented in large-scale clinical trials. Chest pain in women is more likely to be overlooked due to the higher likelihood of atypical presentation and normal anatomical imaging, despite persistent symptoms and decreased quality of life indicators. Accordingly, we call into question a CTCA-first approach in clinical guidelines; instead, we favor a personalized, patient first approach. Due to the misdiagnosis of ischemic heart disease in women, a large proportion are denied access to preventative therapy. This is especially true of women with INOCA, for which there is a critical lack of specific guidelines and rigorous evidencebased therapies. Ongoing clinical trials aim to identify potential management options that may benefit those with INOCA, bringing the field closer to eliminating sex-related disparities in the diagnosis, management and prognosis of ischemic heart disease.

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“…China is facing a great challenge of IHD, with a disability-adjusted of life years (DALY) rate of 2131/100,000 in 2017 (3). The total cost of IHD hospital admissions was the highest among all CVDs in 2018, reaching 111,982 million yuan (4).The major subtypes of IHD include coronary artery disease (CAD) and acute coronary syndromes (ACS) (5).…”

Section: Introductionmentioning

confidence: 99%

“…The total cost of IHD hospital admissions was the highest among all CVDs in 2018, reaching 111,982 million yuan [4]. The major subtypes of IHD include coronary artery disease (CAD) and acute coronary syndromes (ACSs) [5].…”

Section: Introductionmentioning

confidence: 99%

Effect of Meteorological Factors and Air Pollutants on Daily Hospital Admissions for Ischemic Heart Disease in Lanzhou, China

Meng¹,

Jin²,

Han³

et al. 2023

Cardiology

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Background: Meteorological factors and air pollutants are believed to be associated with cardiovascular disease. Ischemic heart disease (IHD) is a major public health issue worldwide. Few studies have investigated the associations among meteorological factors, air pollutants and IHD daily hospital admissions in Lanzhou, China. Methods: We conducted a distributed lag non-linear model (DLNM) on the basis of five years data, aiming at disentangling the impact of meteorological factors and air pollutants on IHD hospital admissions. All IHD daily hospital admissions recorded from January 1, 2015 and December 31, 2019 were obtained from three hospitals in Lanzhou, China. Daily air pollutant concentrations and meteorological data were synchronously collected from Gansu Meteorological Administration and Lanzhou Environmental Protection Administration. Stratified analyses were performed by sex and two age-groups. Results: A total of 23555 IHD hospital admissions were recorded, of which 10477 admissions were for coronary artery disease (CAD), 13078 admissions were for acute coronary syndrome (ACS). Our results showed that there was a non-linear (J-shaped) relationship between temperature and IHD hospital admissions. The number of IHD hospital admissions were positively correlated with NO2, O3, humidity and pressure, indicating an increased risk of hospital admissions for IHD under NO2, O3, humidity and pressure exposure. Meanwhile, both extremely low (-12ºC) and high (30ºC) temperature reduced IHD hospital admissions, but the harmful effect increased with the lag time in Lanzhou, China, while the cold effect was more pronounced and long-lasting than the heat effect. Subgroup analysis demonstrated that the risk on CAD hospital admissions increased significantly in female and <65 years of age at -12ºC. Conclusion: Our findings added to the growing evidence regarding the potential impact of meteorological factors, air pollutants on policymaking from the perspective of hospital management efficiency.

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Effect of Meteorological Factors, Air Pollutants on Daily Hospital Admissions for Ischemic Heart Disease in Lanzhou, China

Meng

¹

,

Jin

²

,

Han

³

et al. 2023

Preprint

1

0

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Background: Meteorological factors and air pollutants are believed to be associated with cardiovascular disease. Ischemic heart disease (IHD) is a major public health issue worldwide. Few studies have investigated the associations among meteorological factors, air pollutants and IHD daily hospital admissions in Lanzhou, China. Methods: We conducted a distributed lag non-linear model (DLNM) on the basis of five years data, aiming at disentangling the impact of meteorological factors and air pollutants on IHD hospital admissions. All IHD daily hospital admissions recorded from January 1, 2015 and December 31, 2019 were obtained from three hospitals in Lanzhou, China. Daily air pollutant concentrations and meteorological data were synchronously collected from Gansu Meteorological Administration and Lanzhou Environmental Protection Administration. Stratified analyses were performed by sex and two age-groups. Results: A total of 23555 IHD hospital admissions were recorded, of which 10477 admissions were for coronary artery disease (CAD), 13078 admissions were for acute coronary syndrome (ACS). Our results showed that there was a non-linear (J-shaped) relationship between temperature and IHD hospital admissions. The number of IHD hospital admissions were positively correlated with NO2, O3, humidity and pressure, indicating an increased risk of hospital admissions for IHD under NO2, O3, humidity and pressure exposure. Meanwhile, both extremely low (-12ºC) and high (30ºC) temperature reduced IHD hospital admissions, but the harmful effect increased with the lag time in Lanzhou, China, while the cold effect was more pronounced and long-lasting than the heat effect. Subgroup analysis demonstrated that the risk on CAD hospital admissions increased significantly in female and <65 years of age at -12ºC. Conclusion: Our findings added to the growing evidence regarding the potential impact of meteorological factors, air pollutants on policymaking from the perspective of hospital management efficiency.

show abstract

What Is the Role of Assessing Ischemia to Optimize Therapy and Outcomes for Patients with Stable Angina and Non-obstructed Coronary Arteries?

Cited by 4 publications

References 77 publications

Reappraising Ischemic Heart Disease in Women

Reappraising Ischemic Heart Disease in Women

Effect of Meteorological Factors and Air Pollutants on Daily Hospital Admissions for Ischemic Heart Disease in Lanzhou, China

Effect of Meteorological Factors, Air Pollutants on Daily Hospital Admissions for Ischemic Heart Disease in Lanzhou, China

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