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      Ischemic Heart Disease in Women

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          Abstract

          Cardiovascular disease is a leading cause of morbidity and death among women. Our knowledge of ischemic heart disease has grown tremendously over the past few decades as sex differences in prevalence, presentation, and pathophysiology are increasingly being recognized. Women with ischemic heart disease have less coronary atherosclerosis than men. Coronary endothelial dysfunction and microvascular disease have been proposed as important mechanisms that contribute to the cause and prognosis of ischemic heart disease in women. This review outlines sex-specific issues in ischemic heart disease, including prevalence, prognosis, pathophysiology, traditional and nontraditional risk factors, screening, and diagnostic testing, as well as management strategies.

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          Most cited references 61

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          2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

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            Analysis of probability as an aid in the clinical diagnosis of coronary-artery disease.

            The diagnosis of coronary-artery disease has become increasingly complex. Many different results, obtained from tests with substantial imperfections, must be integrated into a diagnostic conclusion about the probability of disease in a given patient. To approach this problem in a practical manner, we reviewed the literature to estimate the pretest likelihood of disease (defined by age, sex and symptoms) and the sensitivity and specificity of four diagnostic tests: stress electrocardiography, cardiokymography, thallium scintigraphy and cardiac fluoroscopy. With this information, test results can be analyzed by use of Bayes' theorem of conditional probability. This approach has several advantages. It pools the diagnostic experience of many physicians ans integrates fundamental pretest clinical descriptors with many varying test results to summarize reproducibly and meaningfully the probability of angiographic coronary-artery disease. This approach also aids, but does not replace, the physician's judgment and may assit in decisions on cost effectiveness of tests.
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              Women and ischemic heart disease: evolving knowledge.

              Evolving knowledge regarding sex differences in coronary heart disease is emerging. Given the lower burden of obstructive coronary artery disease (CAD) and preserved systolic function in women, which contrasts with greater rates of myocardial ischemia and near-term mortality compared with men, we propose the term "ischemic heart disease" as appropriate for this discussion specific to women rather than CAD or coronary heart disease (CHD). This paradoxical difference, where women have lower rates of anatomical CAD but more symptoms, ischemia, and adverse outcomes, appears linked to abnormal coronary reactivity that 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 increased compared with men, yet women are less likely to receive guideline-indicated therapies. In the setting of non-ST-segment elevation acute myocardial infarction, interventional strategies are equally effective in biomarker-positive women and men, whereas conservative management is indicated for biomarker-negative women. For women with evidence of ischemia but no obstructive CAD, antianginal and anti-ischemic therapies can improve symptoms, endothelial function, and quality of life; however, trials evaluating impact on adverse outcomes are needed. We hypothesize that women experience more adverse outcomes compared with 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 ischemic heart disease.
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                Author and article information

                Journal
                CVIA
                Cardiovascular Innovations and Applications
                CVIA
                Compuscript (Ireland )
                2009-8782
                2009-8618
                January 2019
                February 2019
                : 3
                : 3
                : 305-315
                Affiliations
                1University of Florida, College of Medicine, 1600 SW Archer Rd, Gainesville, FL 32610, USA
                Author notes
                Correspondence: Ki Park, MD, MS, University of Florida, College of Medicine, Gainesville, FL, USA, E-mail: parkke@ 123456medicine.ufl.edu
                Article
                cvia20190006
                10.15212/CVIA.2019.0006
                Copyright © 2019 Cardiovascular Innovations and Applications

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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