Women and ischemic heart disease: evolving knowledge.
Women and ischemic heart disease: evolving knowledge.
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DOI：
10.1016/j.jacc.2009.04.098
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发表时间：
2009-10-20
影响因子：
24
通讯作者：
Merz, C. Noel Bairey
中科院分区：
文献类型：
--
作者：
Shaw, Leslee J.;Bugiardini, Raffaelle;Merz, C. Noel Bairey
关于冠心病（CHD）性别差异的知识正在不断发展。考虑到与男性相比，女性患阻塞性冠状动脉疾病（CAD）的负担较低，收缩功能较好，而心肌缺血和近期死亡率较高，我们建议用缺血性心脏病（IHD）一词来代替CAD或冠心病，更适合女性的讨论。这种矛盾的差异是，女性的解剖性CAD发病率较低，但更多的症状、缺血和结果似乎与冠状动脉反应性（包括微血管功能障碍）有关。新的危险因素可以提高Framingham风险评分，包括炎症标志物和生殖激素，以及无创成像和功能能力测量。与男性相比，女性患阻塞性CAD的风险较高，但女性接受指南指示的治疗的可能性较小。在非st段抬高急性心肌梗死的情况下，介入策略对生物标志物阳性的女性和男性同样有效，而对生物标志物阴性的女性则适用保守治疗。对于有缺血证据但无阻塞性CAD的女性，抗心绞痛和抗缺血治疗可以改善症状、内皮功能和生活质量；然而，需要评估不良结果的试验。我们假设，与男性相比，女性经历了更多的不良后果，因为阻塞性CAD仍然是目前治疗策略的重点。持续的研究表明，设计治疗方案，以改善症状负担和减少IHD妇女的风险。
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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