IMR Press / RCM / Volume 24 / Issue 4 / DOI: 10.31083/j.rcm2404118
Open Access Review
Reappraising Ischemic Heart Disease in Women
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1 British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, G12 8QQ Glasgow, Scotland, UK
2 The West of Scotland Heart and Lung Centre, NHS Golden Jubilee, G81 4DY Glasgow, Scotland, UK
*Correspondence: colin.berry@glasgow.ac.uk (Colin Berry)
Rev. Cardiovasc. Med. 2023, 24(4), 118; https://doi.org/10.31083/j.rcm2404118
Submitted: 14 October 2022 | Revised: 17 January 2023 | Accepted: 7 February 2023 | Published: 18 April 2023
(This article belongs to the Special Issue Cardiovascular Disease in Women)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

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 evidence-based 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.

Keywords
ischemic heart disease
microvascular disease
sex
angina
pathophysiology
prognosis
Funding
RE/18/6134217/British Heart Foundation Centre of Research Excellence award
Figures
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