Women’s Ischemic Syndrome Evaluation

Abstract

Endorsed by the American College of Cardiology Foundation T he WISE workshop was convened to review results from the Women's Ischemic Syndrome Evaluation (WISE) study and other studies of ischemic heart disease to examine the nature and scope of gender differences in both chronic and acute cardiac ischemia, in terms of clinical manifestations, detection, and treatment. The purpose of the workshop was to provide recommendations to National Heart, Lung and Blood Institute that (1) address the need for improved diagnosis of ischemia and coronary artery disease (CAD) in women; (2) explore strategies for improved translation of promising research results into clinical practice; and (3) assess opportunities for effective educational strategies, including further refinement of the key messages for women with regard to risk factors and heart attack symptoms. Workshop Objectives• To identify opportunities and needs in current state-of-theart knowledge in gender differences in manifestation and detection of ischemia and CAD in women.• To identify opportunities and provide recommendations on gender-based education for health professionals, patients, and the public.• To recommend future research directions in ischemia and CAD in women.CAD in women continues to be a major public health problem that represents a leading cause of death and disability. 1-3 Among US women, more than a quarter of a million deaths per year are attributed to CAD, and this figure is expected to increase in the first decades of the 21st century as our population ages. The increased prevalence of obesity and diabetes in women is also expected to contribute to this increase in CAD. Women have a higher frequency of angina/ chest pain than men; however, women have a lower prevalence of obstructive CAD compared with men with similar symptoms. 4 -6 Nevertheless, young women with obstructive CAD experience a significantly worse outcome compared with men with regard to prognosis after myocardial infarction, 7 and older women with obstructive CAD often have greater comorbidities that influence their outcome adversely after acute myocardial infarction or myocardial revascularization than do men. 8 -11 Women presenting with acute coronary syndromes (ACS) are also less likely to receive effective acute diagnostic and treatment strategies than men. [12][13][14] The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.

The Economic Burden of Angina in Women With Suspected Ischemic Heart Disease

“…Although this is the topic of much ongoing research, it is noteworthy that prior reports have uniformly noted that women with the cardiac syndrome X have excellent near-term cardiac survival compared with women with obstructive CAD. 18,23,37 Our current data are consistent with these reports, noting that women with nonobstructive CAD were at relatively low risk for cardiovascular death. However, when related morbidity is considered, including refractory chest pain symptoms requiring hospitalization, the women with nonobstructive CAD perhaps should be reclassified as being at intermediate risk compared with those with obstructive disease.…”

“…11,17,18 Study procedures and follow-up methods were approved by each center's institutional review board.…”

Self-Rated Versus Objective Health Indicators as Predictors of Major Cardiovascular Events: The NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation

“…Finally, our results may support a particular clinical role for self-rated health measures among women presenting to cardiology settings. The gender discrepancy in the sensitivity and specificity of standard cardiac symptoms and ischemia tests is well documented (26), with the possible outcome being less aggressive assessment and treatment among women (37). Self-rated health measures may offer an additional tool for providers to use in gauging the clinical risk of symptomatic patients similar to those participating in WISE.…”

Sex Differences in Nonculprit Coronary Plaque Microstructures on Frequency-Domain Optical Coherence Tomography in Acute Coronary Syndromes and Stable Coronary Artery Disease

“…1,2 More than a quarter of a million women die each year in the United States because of CAD, with projections that this will rise during the next few decades. 1,2 This highlights the need to better understand the factors promoting atherosclerotic events and to establish more effective therapeutic approaches in women.…”