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STATE-OF-THE-ART PAPER

Insights From the NHLBI-Sponsored Women’s Ischemia Syndrome Evaluation (WISE) Study

Part II: Gender Differences in Presentation, Diagnosis, and Outcome With Regard to Gender-Based Pathophysiology of Atherosclerosis and Macrovascular and Microvascular Coronary Disease

C. Noel Bairey Merz, MD, FACC^_*,_*, Leslee J. Shaw, PhD^_*, Steven E. Reis, MD, FACC, Vera Bittner, MD, FACC^#, Sheryl F. Kelsey, PhD, Marian Olson, MS, B. Delia Johnson, PhD, Carl J. Pepine, MD, MACC, Sunil Mankad, MD, FACC^||, Barry L. Sharaf, MD, FACC^¶, William J. Rogers, MD, FACC^#, Gerald M. Pohost, MD, FACC^_**, Amir Lerman, MD, FACC, Arshed A. Quyyumi, MD, FACC, George Sopko, MD for the WISE Investigators

^_* Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California
Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
Division of Cardiology, Department of Medicine, University of Florida, Gainesville, Florida
^|| Division of Cardiology, Department of Medicine, Allegheny University of the Health Sciences, Pittsburgh, Pennsylvania
^¶ Division of Cardiology, Rhode Island Hospital, Providence, Rhode Island
^# Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
^_** Division of Cardiology, University of Southern California, Los Angeles, California
Division of Cardiology, Mayo Clinic, Rochester, Minnesota
Division of Cardiology, Emory University, Atlanta, Georgia
National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.

Manuscript received October 19, 2004; revised manuscript received December 7, 2004, accepted December 20, 2004.

^_* Reprint requests and correspondence: Dr. C. Noel Bairey Merz, c/o WISE Coordinating Center, University of Pittsburgh, 127 Parran Hall, Graduate School of Public Health, 130 DeSoto Street, Pittsburgh, Pennsylvania 15261. (Email: Noel.BaireyMerz{at}cshs.org).

Coronary heart disease is the leading cause of death and disability in the U.S., but recent advances have not led to declines in case fatality rates for women. The current review highlights gender-specific issues in ischemic heart disease (IHD) presentation, evaluation, and outcomes with a special focus on the results derived from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. In the second part of this review, we will assess new evidence on gender-based differences in vascular wall or metabolic alterations, atherosclerotic plaque deposition, and functional expression on worsening outcomes of women. Additionally, innovative cardiovascular imaging techniques will be discussed. Finally, we identify critical areas of further inquiry needed to advance this new gender-specific IHD understanding into improved outcomes for women.

Abbreviations and Acronyms   C-IMT = carotid intima-media thickness   CT = computed tomography   FMD = flow-mediated dilation   IHD = ischemic heart disease   LV = left ventricular   MI = myocardial infarction   NRMI = National Registry of Myocardial Infarction

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