Women's Ischemic Syndrome Evaluation: current status and future research directions: report of the National Heart, Lung and Blood Institute workshop: October 2-4, 2002: Section 2: stable ischemia: pathophysiology and gender differences.

Abstract

The 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. This section addresses research needs in understanding the pathophysiology of chronic myocardial ischemic syndromes in women and mechanisms for gender differences. Flow-limiting stenoses within epicardial coronary arteries (obstructive coronary artery disease [CAD]) may cause myocardial ischemia, which is sensed as angina pectoris or dyspnea and is associated with characteristic electrocardiographic, perfusion, or left ventricular functional abnormalities, on conventional testing in women with CAD, as in men. The issue of contention for several decades has been whether women who do not have obstructive CAD experience myocardial ischemia by a pathophysiology different from that of the majority of men with CAD. In this regard, several large cohort studies, including the Coronary Artery Surgery Study sponsored by the National Heart, Lung and Blood Institute,1 documented that women (mean age of 54 years) presenting with chest pain are less likely to have obstructive CAD at diagnostic coronary angiography than are men. In the WISE cohort, the majority of women (mean age of 59±12 years) were not found to have obstructive CAD at catheterization.2 Some of this disparity may be explained by the Bayes theorem, where the prevalence of age-predicted obstructive CAD in women is lower than in men. Possible explanations for chest pain in this setting include (1) underestimation of the extent and severity of …