Ischemic Heart Disease In Women Research Articles

Ischemic heart disease risk factors in postmenopausal women

Purpose: To assess risk factors of ischemic heart disease in women with surgical menopause. Methods: 141 women with surgical menopause were included in the investigation. All of them underwent general clinical examination, body mass index (BMI) calculation, measurement of waist circumference, menopausal index evaluation, ambulatory blood pressure and electrocardiogram monitoring (Cardiotens-01, Meditech, Hungary), determination of general cholesterol, lipid fractions and glucose tolerance. We also measured the level of non-etherized fatty acids and glycerol in blood serum.

Heart exposure in 100 consecutive, unselected patients treated with adjuvant 3D conformal radiotherapy for left-sided breast cancer.

103 Background: Women treated with radiotherapy for left-sided breast cancer may have their heart exposed to doses ranging from 1 to 7 Gy on the average. This was confirmed by a recent study* focusing on the ischemic risk based on medical records dating back to 1950s. Modern 3D conformal radiotherapy (3D-CRT), however, may play a major role in heart-sparing irradiation. Methods: We reviewed the treatment planning records and dose-volume histograms of 100 consecutive, unselected patients (pts) affected with left-sided breast cancer who underwent adjuvant 3D-CRT after either quadrantectomy (90 pts) or mastectomy (10 pts) in our center during the year 2011. Median age was 52 (range 42-90). The whole breast (or chest wall) received 50 Gy / 25 fractions in 66 pts and 45 Gy / 18 fractions in 34. Boost to surgical bed (10 Gy / 4-5 fractions) was delivered by photons in 10 pts. Median number of tangential fields was 2 (range 2-4). All treatments were performed in the supine position. Results: The average of the median doses to the whole heart was 2.89 Gy (range 0.8 to 13.05). Median doses were: 1.15 to 1.99 Gy in 21 pts; 2.01 to 3.00 Gy in 32 pts; 3.06 to 3.98 Gy in 16 pts; 4.16 to 4.83 Gy in 13 pts. Median dose only exceeded 5 Gy in 17 pts. One pt received less than 1 Gy and one pt more than 13 Gy. Median volumes (mV) of heart exposed to 5 Gy, 10 Gy and 15 Gy were: mV5 ≤ 4% (range 1 to 42%), mV10 ≤ 3% (0 to 30%), mV15 ≤ 2% (0 to 24%). Conclusions: The average doses we registered are lower than those (4.9 Gy, range 0.03 to 27.72) reported in the large investigation by Darby et al.*. Although related to a small case series, our data confirm that contemporary 3D conformal techniques allow reduced median doses to the whole heart with potential favorable impact on the risk of radiation-induced cardiac disease in the coming decades. Estimate of cardiac involvement in breast cancer radiotherapy based on older case series and outdated treatment techniques may be misleading. *Darby SC et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer. NEJM 368, 11, 2013.

Ischemic Heart Disease and Its Related Factors in Mongolia: A Nationwide Survey

Ischemic heart disease (IHD) remains one of the most important disorders associated with disability and mortality worldwide, and is one of the major causes of cardiovascular diseases in Mongolia. The objective of the current study was to determine the prevalence of IHD and its related factors in a general population in Mongolia. We conducted a nationwide cross-sectional survey between March and September, 2009. General participants were recruited from urban to rural regions in a multistage random cluster sampling method. The diagnosis of IHD was based on the Rose questionnaire (World Health Organization) and electrocardiographic findings. A total of 369 (16.2%) subjects with IHD were diagnosed among 2,280 participants. The prevalence of subjects with IHD was significantly increased by age: from 9.9% in individuals age 40-44years compared to 17.7% in those over 60years. Smoking habits (former and current) and non-frequent intake of fruits and vegetables were significantly positively associated with IHD in men, while heavy alcohol drinking habits and lower education period of time were significantly positively associated with IHD in women. IHD was found to be prevalent, especially among people aged over 40years, in Mongolia. Statistical factors related to IHD were found to be significantly different based on sex. The current data may provide relevant information to prevent IHD in the Mongolian population.

Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer

BackgroundRadiotherapy for breast cancer often involves some incidental exposure of the heart to ionizing radiation. The effect of this exposure on the subsequent risk of ischemic heart disease is uncertain.MethodsWe conducted a population-based case–control study of major coronary events (i.e., myocardial infarction, coronary revascularization, or death from ischemic heart disease) in 2168 women who underwent radiotherapy for breast cancer between 1958 and 2001 in Sweden and Denmark; the study included 963 women with major coronary events and 1205 controls. Individual patient information was obtained from hospital records. For each woman, the mean radiation doses to the whole heart and to the left anterior descending coronary artery were estimated from her radiotherapy chart.ResultsThe overall average of the mean doses to the whole heart was 4.9 Gy (range, 0.03 to 27.72). Rates of major coronary events increased linearly with the mean dose to the heart by 7.4% per gray (95% confidence interval, 2.9 to 14.5; P<0.001), with no apparent threshold. The increase started within the first 5 years after radiotherapy and continued into the third decade after radiotherapy. The proportional increase in the rate of major coronary events per gray was similar in women with and women without cardiac risk factors at the time of radiotherapy.ConclusionsExposure of the heart to ionizing radiation during radiotherapy for breast cancer increases the subsequent rate of ischemic heart disease. The increase is proportional to the mean dose to the heart, begins within a few years after exposure, and continues for at least 20 years. Women with preexisting cardiac risk factors have greater absolute increases in risk from radiotherapy than other women. (Funded by Cancer Research UK and others.)

Sex- and age-related differences of myocardial perfusion at rest assessed with multidetector computed tomography

BackgroundThe clinical presentation of ischemic heart disease in women differs from men, which could reflect sex-related differences of normal physiology. Cardiac CT angiography provides a noninvasive method to assess both regional and transmural myocardial perfusion in addition to coronary atherosclerosis. ObjectiveThe aim of this study was to evaluate potential sex-related differences of (1) left ventricular (LV) myocardial perfusion measured as LV myocardial attenuation density/LV blood pool attenuation density (MyoAD-ratio) at rest and (2) transmural perfusion ratio (TPR) as a measure of endocardial perfusion relative to epicardial perfusion. MethodsMyocardial perfusion at rest and coronary artery atherosclerosis were evaluated with multidetector CT in 206 asymptomatic women and 203 age-matched men from the Copenhagen General Population Study. ResultsLV myocardial perfusion at rest (LV MyoAD-ratio) was higher in women than in men (9% difference; P = 0.039). In a multivariable analysis, including age, sex, cardiovascular risk factors, Agatston score, and presence of coronary stenosis, global LV MyoAD-ratio remained significantly higher in women than in men (P = 0.045). No effect of cardiovascular risk factors on myocardial perfusion at rest was noted. Myocardial perfusion at rest was correlated to age in men (r = 0.15, P = 0.031) but not in women (r = −0.01, P = 0.83). TPR was slightly lower in women than in men (1.12 vs 1.14; P = 0.0019). ConclusionLV myocardial perfusion at rest is higher in women than men independent of coronary atherosclerosis in asymptomatic subjects with risk factors.

Trends in Ischemic Heart Disease Mortality in Korea, 1985-2009: An Age-period-cohort Analysis

ObjectivesEconomic growth and development of medical technology help to improve the average life expectancy, but the western diet and rapid conversions to poor lifestyles lead an increasing risk of major chronic diseases. Coronary heart disease mortality in Korea has been on the increase, while showing a steady decline in the other industrialized countries. An age-period-cohort analysis can help understand the trends in mortality and predict the near future.MethodsWe analyzed the time trends of ischemic heart disease mortality, which is on the increase, from 1985 to 2009 using an age-period-cohort model to characterize the effects of ischemic heart disease on changes in the mortality rate over time.ResultsAll three effects on total ischemic heart disease mortality were statistically significant. Regarding the period effect, the mortality rate was decreased slightly in 2000 to 2004, after it had continuously increased since the late 1980s that trend was similar in both sexes. The expected age effect was noticeable, starting from the mid-60's. In addition, the age effect in women was more remarkable than that in men. Women born from the early 1900s to 1925 observed an increase in ischemic heart mortality. That cohort effect showed significance only in women.ConclusionsThe future cohort effect might have a lasting impact on the risk of ischemic heart disease in women with the increasing elderly population, and a national prevention policy is need to establish management of high risk by considering the age-period-cohort effect.

The enigma of heart disease in women: New insights may precipitate diagnosis and improve patient outcomes

To highlight the unique pathophysiology and clinical presentation of ischemic heart disease in women. The article will emphasize the atypical clinical manifestations, reinforce the pitfalls of standard testing, and provide new insights into novel risk factors as well as diagnostic tools to enable earlier detection of disease. An extensive review of the literature was conducted using Pub Med and CINAHL databases. The reference lists of applicable published reports were also reviewed. Significant evidence now exists to support the presence of coronary ischemia even in the absence of obstructive epicardial coronary occlusions. Coronary microvascular disease and/or endothelial dysfunction account for roughly 50% of heart disease cases in women. Understanding the different pathophysiologic mechanisms of coronary disease, the uncommon expression of symptoms, and the avoidance of over-reliance on standard testing to reveal disease is essential for early and accurate diagnosis. A lack of awareness persists regarding the phenomenon of ischemic heart disease in women. Healthcare providers must optimize their understanding of these variations and implement strategies for early recognition and treatment. Evaluation of novel risk factors, coronary calcium screening, evaluation of endothelial function, and estimation of functional capacity offers significant advantages over traditional evaluations.

Is menopause a risk factor for ischemic heart disease in women?

Cardiovascular diseases (CVD) are the leading cause of morbidity and mortality in men and women worldwide. The apparent cardioprotective effects of endogenous estrogens seem to prevent CVD in premenopausal women. Following menopause and loss of hormonal effects, gender-based differences in CVD are reduced, with the CVD risk being higher in women who develop the metabolic syndrome. In postmenopausal women, many features of the metabolic syndrome emerge with estrogen deficiency. Estrogen deficiency occurring in the menopausal period is associated with 1) dyslipidemia (hypertriglyceridemia, reduced HDL, and increased small dense LDL particles); 2) insulin resistance; 3) hypertension; 4) increased central fat and reduction in lean body mass; and 5) increased hypercoagulability and pro-inflammatory state. In addition to traditional cardiovascular risk factors, also early menopause has a negative impact on females. Over the past years, different approaches were found to improve quality of life and cardiovascular health in menopausal women. Since the concept of hormone replacement therapy (HRT), large observational studies and randomized clinical trials have amassed a wealth of data about the effects of menopause and the safety and efficacy of using estrogen replacement therapies to treat menopause symptoms and menopause-related diseases. While there is no question that HRT effectively mitigates troublesome menopause symptoms, conflicting evidence about other effects of HRT has fueled controversy concerning its relative benefits and risks. Moreover, it seems that CVD protection mediated by replacement therapy is maximum when treatment is initiated in the absence of signs of atherosclerosis (typically in the premenopausal period), whereas it vanishes as atherosclerosis progresses (postmenopausal period). However, many questions remain unsolved regarding the effectiveness of hormonal compounds, doses, regimens, and route of administration. On the basis of these considerations, it is necessary in the near future to expand scientific knowledge and develop appropriate lifestyle modifications and therapeutic strategies for the treatment of either traditional cardiovascular risk factors or menopause-related metabolic changes.

Ischemic heart disease in women

Nowadays, Coronary Diseases (CDs) represent the main mortality cause in men and women, but there are gender differences regarding their presentation, progression and the way the disease is tackled. This study mainly focuses on reviewing literature about the CD and its gender approach. The authors carried out a search of texts that use qualitative methodology, published between 2003 and 2009 in the following databases: PUBMED, IME, CUIDEN and CINAHL. Factors that hinder the early diagnosis of Ischemic Heart Disease in women are identified as the main findings, and the possible consequences are pointed out. In the fifty-six texts that were selected initially, we can see the difficulty women face to recognize early symptoms of the CD and their low risk perception of this disease. Greater awareness on Ischemic Heart Disease is needed, so that the high morbidity and mortality rates can be reduced.

P1-336 Validation of NHS hospital admission records for ischaemic heart disease in the million women study

IntroductionThe Million Women Study is a large longitudinal UK study of women's health. Between 1996 and 2001, 1.3 million women mostly aged 50–64 years were recruited through NHS breast screening...

P2-36 Body mass index and risk of incident ischaemic heart disease in women: a prospective cohort study

BackgroundVarious studies have examined body mass index in relation to mortality due to ischaemic heart disease (IHD), but few data are available on incident IHD including non-fatal events particularly in...

The Importance of Gender Differences in the Diagnosis and Management of Cardiovascular Disease

For many years, the majority of the observational and epidemiological studies assessing coronary artery disease patients, national and international clinical guidelines, registries and randomized trials have focused almost exclusively on men whereas women were usually excluded in most series. This underrepresentation of women in the medical literature in this field has resulted in few data being available regarding the clinical course of the condition, its management and clinical outcomes in this specific population, despite the relatively high prevalence of ischemic heart disease in women. The situation has changed -at least partially- in the past few years with publications focusing on this issue and reporting the existence of inequalities between genders regarding the diagnosis and treatment of coronary heart disease. This article will briefly review gender differences in the clinical presentation, diagnostic strategies and prognosis of coronary heart disease.

Cardiovascular Disease in Young Women

Ischemic heart disease (IHD) is a leading cause of morbidity in the United States and worldwide. In women, it is the leading cause of death in all age groups except young women who rarely have clinically evident disease. However, when young women less than age 50 develop IHD, they are at high risk for mortality. This may be due in part to delay in diagnosis or less aggressive treatment. Young women may be less aggressively treated with medical therapies and percutaneous or surgical interventions despite studies that have shown benefit in women as well as men. Young women are an especially important population to target for treatment and study since prevention of IHD during this stage of life can have great personal and societal health consequences. Epidemiological studies, including the INTERHEART study, have identified risk factors including hypertension, diabetes, metabolic syndrome, smoking, and sedentary lifestyle that explain much of IHD in women. Several factors, including diabetes, metabolic syndrome, and tobacco use, are stronger predictors of IHD in young women as compared with older women. Healthcare practitioners who encounter young women should aggressively treat risk factors, maintain an appropriate index of suspicion for IHD, and treat acute coronary syndromes promptly and intensively to reduce the burden of IHD in young women.

Promoting predictive, preventive and personalized medicine in treatment of cardiovascular diseases

Promoting predictive, preventive and personalized medicine in treatment of cardiovascular diseases

Ischemic Heart Disease in Women: A Review for Primary Care Physicians

Ischemic heart disease (IHD) is the leading cause of death among women in the Western world, and its prevalence is growing. The pathophysiology of heart disease in women differs from that in men. Women with chest pain and abnormal stress tests are less likely than men to have critical stenosis of coronary arteries, a phenomenon attributed to endothelial dysfunction. Hypertension, intimal injury, and cholesterol are among the various factors that contribute to endothelial dysfunction. The presenting symptoms of IHD also differ in women. Women are more likely to describe neck and throat pain and to characterize the pain as intense, sharp, or burning. A history of coronary or other vascular disease, diabetes, or chronic kidney disease places patients at high risk for IHD. Risk factor modification can be tailored based on each patient's risk. Hormone replacement therapy, antioxidants, folic acid, and aspirin in healthy women under 65 years of age have recently been shown to be ineffective in the prevention of IHD.

Ischaemic heart disease in women: are there sex differences in pathophysiology and risk factors?: Position Paper from the Working Group on Coronary Pathophysiology and Microcirculation of the European Society of Cardiology

Cardiovascular disease (CVD) is the leading cause of death in women, and knowledge of the clinical consequences of atherosclerosis and CVD in women has grown tremendously over the past 20 years. Research efforts have increased and many reports on various aspects of ischaemic heart disease (IHD) in women have been published highlighting sex differences in pathophysiology, presentation, and treatment of IHD. Data, however, remain limited. A description of the state of the science, with recognition of the shortcomings of current data, is necessary to guide future research and move the field forward. In this report, we identify gaps in existing literature and make recommendations for future research. Women largely share similar cardiovascular risk factors for IHD with men; however, women with suspected or confirmed IHD have less coronary atherosclerosis than men, even though they are older and have more cardiovascular risk factors than men. Coronary endothelial dysfunction and microvascular disease have been proposed as important determinants in the aetiology and prognosis of IHD in women, but research is limited on whether sex differences in these mechanisms truly exist. Differences in the epidemiology of IHD between women and men remain largely unexplained, as we are still unable to explain why women are protected towards IHD until older age compared with men. Eventually, a better understanding of these processes and mechanisms may improve the prevention and the clinical management of IHD in women.

Psychosocial work environment and risk of ischaemic heart disease in women: the Danish Nurse Cohort Study

ObjectivesTo investigate the effect of work pressure and job influence on the development of ischaemic heart disease (IHD) in women.MethodsThe effect of work pressure and job influence on the 15-year...

Digital Assessment of Endothelial Function and Ischemic Heart Disease in Women

We investigated the utility of digital reactive hyperemia peripheral arterial tonometry (RH-PAT) in predicting ischemic heart disease (IHD), including obstructive coronary artery disease (CAD) and nonobstructive coronary artery disease (NOCAD), in women. IHD is the leading cause of mortality, and its pathogenesis is diverse in women. Fingertip RH-PAT is a new device that provides noninvasive, automatic, and quantitative evaluation of endothelial dysfunction. RH-PAT was measured using Endo-PAT2000 (Itamar Medical, Caesarea, Israel) before cardiac catheterization in 140 stable women scheduled for hospitalization to examine chest pain. NOCAD was diagnosed by angiography with measurement of coronary blood flow and cardiac lactate production during intracoronary acetylcholine provocation test and cardiac scintigraphy with stress tests. Sixty-eight women (49%) had obstructive CAD and 42 women (30%) had NOCAD. RH-PAT indexes were significantly attenuated in both obstructive CAD and NOCAD as compared with non-IHD (n = 30) (obstructive CAD: median 1.57, interquartile range [IQR] 1.42 to 1.76; NOCAD: median 1.58, IQR 1.41 to 1.78; non-IHD: median 2.15, IQR 1.85 to 2.48, p < 0.001). By multivariate logistic regression analysis, only RH-PAT index was significantly associated with IHD, including obstructive CAD and NOCAD (odds ratio 0.51; 95% confidence interval: 0.38 to 0.68; p < 0.001). In receiver-operating characteristic analysis, RH-PAT index was a significant predictor of IHD (area under the curve 0.86; p < 0.001). Furthermore, only RH-PAT was useful for the prediction of NOCAD after excluding obstructive CAD (area under the curve 0.85; p < 0.001; RH-PAT index of <1.82 had 81% sensitivity and 80% specificity). RH-PAT indexes were significantly attenuated in women with IHD. Digital RH-PAT can predict patients with IHD, especially NOCAD before angiography. RH-PAT is potentially useful for identifying high-risk women for IHD. (Endothelial Dysfunction and Coronary Artery Spasm; NCT00619294).

Noninvasive Assessment of Coronary Artery Disease in Women: What’s Next?

Significant progress in research has been made in the areas of sex-specific aspects of cardiovascular disease. Despite these advances, coronary artery disease (CAD) is the leading cause of death of women in the Western world. Over the past decade, the focused research on women at risk for ischemic heart disease has helped to clarify our understanding of some of the sex-specific factors, which are important in detecting CAD. In women, the detection and evaluation of physiologically significant CAD is challenging, especially given that traditional tests designed to detect focal areas of coronary artery stenosis are less sensitive and specific in female patients who have a lower prevalence of obstructive coronary disease, greater burden of symptoms, and a high atherosclerotic burden. In this article, we review the available evidence on the role of contemporary cardiovascular imaging techniques in evaluating ischemic heart disease in women.

Ischemic Heart Disease in Women

After at least 2 decades of growing awareness on coronary heart disease in women, we are left with many questions, few answers, and plenty of opinions. Review articles, books, sessions at scientific meetings, and commentaries regarding various aspects of heart disease in women have proliferated. These reports have highlighted important sex differences in the pathophysiology, presentation, and treatment of ischemic heart disease and have denounced pervasive sex-related disparities in referral and treatment for heart disease as a major reason for outcome differences between the sexes. Such activities have been useful in driving attention to heart disease in women, an area largely ignored by the scientific community and the public just 15 to 20 years ago. However, we must recognize that to date, limited data substantiate many of these statements; such recognition is important to guide future research efforts. A careful look at recently published literature reveals only modest advancements toward clarifying sex-based differences in the pathophysiology of ischemic heart disease and sex-based differences in outcome. At the same time, key questions concerning strategies for prevention and treatment of heart disease in women remain unanswered, and cardiovascular clinical trials continue to include fewer women than men.1 A fundamental question is whether the mechanisms underlying ischemic heart disease in women differ from those in men. This is an important question because if pathophysiology differs in women, such differences can inform strategies for prevention, detection, and treatment that would be most effective for women. That pathophysiology may differ in women compared with men is suggested by several factors. First, despite having more symptoms and physical limitations,2,3 women have less obstructive coronary heart disease than men along the entire spectrum of acute coronary syndromes4 and when referred for revascularization.5,6 Second, the syndrome of chest pain without obstructive coronary artery disease …