Myocardial Ischemia in Women: Lessons From the NHLBI WISE Study

Abstract

Cardiovascular disease (CVD) remains the leading cause of death for women. For almost 3 decades, more women than men have died from CVD, with the most recent annual statistics on mortality reporting that CVD accounted for 421 918 deaths among women in the United States. Although there have been significant declines in coronary heart disease (CHD) mortality for females, these reductions lag behind those seen in men. In addition, where there has been a decrease in mortality from CHD across all age groups over time in men, in the youngest women (age <55 years) there has been a notable increase in mortality from CHD. There are differences in the prevalence, symptoms, and pathophysiology of myocardial ischemia that occurs in women compared with men. In this paper, we review the pathophysiology and mechanisms of ischemic heart disease (IHD) in women, particularly focusing on what we have learned from the WISE study. We examine the sex‐specific issues related to myocardial ischemia in women in terms of prevalence and prognosis, traditional and novel risk factors, diagnostic testing, as well as therapeutic management strategies for IHD. © 2012 Wiley Periodicals, Inc. This work was supported by contracts from the National Heart, Lung, and Blood Institute, nos. N01‐HV‐68161, N01‐HV‐68162, N01‐HV‐68163, N01‐HV‐68164, and R01 HL090957‐01A1; grants U0164829, U01 HL649141, U01 HL649241, T32HL69751, and R03 AG032631‐01 from the National Institute on Aging; a GCRC grant MO1‐RR00425 from the National Center for Research Resources; and grants from the Gustavus and Louise Pfeiffer Research Foundation, Danville, New Jersey; the Women's Guild of Cedars‐Sinai Medical Center, Los Angeles, California; the Edythe L. Broad Women's Heart Research Fellowship, Cedars‐Sinai Medical Center, Los Angeles, California; and the Barbra Streisand Women's Cardiovascular Research and Education Program, Cedars‐Sinai Medical Center, Los Angeles. The authors have no other funding, financial relationships, or conflicts of interest to disclose.