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STATE-OF-THE-ART PAPER

Some Thoughts on the Vasculopathy of Women With Ischemic Heart Disease

Carl J. Pepine, MD, MACC^_*,_*, Richard A. Kerensky, MD, FACC^_*, Charles R. Lambert, MD, PhD, FACC^_*, Karen M. Smith, MD, FACC^_*, Gregory O. von Mering, MD, FACC^_*, George Sopko, MD and C. Noel Bairey Merz, MD, FACC

^_* Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, Gainesville, Florida
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
Division of Cardiology, Department of Medicine, Cedars-Sinai Research Institute, Cedars-Sinai Medical Center, Los Angeles, California.

Manuscript received September 21, 2005; accepted September 29, 2005.

^_* Reprint requests and correspondence: Dr. Carl J. Pepine, Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32610. (Email: pepincj{at}medicine.ufl.edu).

Considerable experimental and clinical data indicate that sex has an important influence on cardiovascular physiology and pathology. This report integrates selected literature with new data from the Women’s Ischemia Syndrome Evaluation (WISE) on vascular findings in women with ischemic heart disease (IHD) and how these findings differ from those in men. A number of common vascular disease-related conditions are either unique to (e.g., hypertensive disorders of pregnancy, gestational diabetes, peripartum dissection, polycystic ovarian syndrome, etc.) or more frequent (e.g., migraine, coronary spasm, lupus, vasculitis, Raynaud’s phenomenon, etc.) in women than men. Post-menopausal women more frequently have many traditional vascular disease risk conditions (e.g., hypertension, diabetes, obesity, inactivity, and so on), and these conditions cluster more frequently in them than men. Considerable evidence supports the notion that, with these requisite conditions, women develop a more severe or somewhat different form of vascular disease than men. Structurally, women’s coronary vessels are smaller in size and appear to contain more diffuse atherosclerosis, their aortas are stiffer (fibrosis, remodeling, and so on), and their microvessels appear to be more frequently dysfunctional compared with men. Functionally, women’s vessels frequently show impaired vasodilator responses. Limitations of existing data and higher risks in women with acute myocardial infarction, need for revascularization, or heart failure create uncertainty about management. A better understanding of these findings should provide direction for new algorithms to improve management of the vasculopathy underlying IHD in women.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CAD = coronary artery disease   CV = cardiovascular   EPC = endothelial progenitor cell   IHD = ischemic heart disease   WISE = Women’s Ischemia Syndrome Evaluation

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