Abstract
BackgroundCardiovascular disease (CVD) remains the leading cause of death for females in the United States accounting for over 412 000 female deaths in 2016. CVD mortality in young women <55 years old remains significantly high and greater than that in men.HypothesisThere is a void with regards to awareness of CVD in women. Many traditional CVD risk estimate tools fail to identify the “at risk” female and is true for the young female patient. There needs to be a shift in focus from looking for the vulnerable plaque to looking for the “at risk” patient.MethodsThis review outlines the emerging misunderstood presentations of CVD in young women which include certain categories of myocardial infarction (MI) with non‐obstructive coronary arteries (MINOCA), such as spontaneous coronary artery dissection (SCAD), as well as the more stable myocardial ischemia with non‐obstructive coronary arteries (INOCA) category focusing on mental stress‐induced myocardial ischemia (MSIMI).ResultsThe prevalence of MINOCA in patients presenting with MI is greater in women. In younger women with CVD, SCAD is an emerging misunderstood presentation in this group of patients with type 2 SCAD being the most common form. MSIMI, a form of INOCA, is more common in women with CVD.ConclusionsThere are emerging misunderstood factors that are prevalent in young women, such as SCAD and MSIMI. It is important to recognize their presentations in young women to prevent misdiagnosis, missed diagnosis as well as mismanagement of these patients to improve their clinical outcomes.
Highlights
INTRODUCTION AND SIGNIFICANCECardiovascular disease (CVD) remains the leading cause of death for females in the United States, accounting for over 412 000 female deaths in 2016.1 CVD is not just a man's disease, an equal number of women and men die from CVD each year in the United States (US)[1])
There is a significant void with regards to awareness of CVD in women for both the public and the medical profession. The presence of this void was showed by a survey performed by the Women's Heart Alliance in 2017.4 This study showed that only 45% of women are aware of CVD being the leading cause of death
A novel taxonomy for young women presenting with MI was developed by Spatz et al to assist in defining the various etiologies of MIs in young women-(variation in recovery: role of gender on outcomes of young acute myocardial infarction patients) VIRGO taxonomy.[6]
Summary
Cardiovascular disease (CVD) remains the leading cause of death for females in the United States accounting for over 412 000 female deaths in 2016. Methods: This review outlines the emerging misunderstood presentations of CVD in young women which include certain categories of myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), such as spontaneous coronary artery dissection (SCAD), as well as the more stable myocardial ischemia with non-obstructive coronary arteries (INOCA) category focusing on mental stress-induced myocardial ischemia (MSIMI). Results: The prevalence of MINOCA in patients presenting with MI is greater in women. In younger women with CVD, SCAD is an emerging misunderstood presentation in this group of patients with type 2 SCAD being the most common form. MSIMI, a form of INOCA, is more common in women with CVD. Conclusions: There are emerging misunderstood factors that are prevalent in young women, such as SCAD and MSIMI. KEYWORDS artery dissection, cardiovascular disease, emerging, ischemia, ischemic heart disease, misunderstood, mental stress, myocardial infarction, spontaneous coronary, women
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