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STATE-OF-THE-ART PAPER

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

Part I: Gender Differences in Traditional and Novel Risk Factors, Symptom Evaluation, and Gender-Optimized Diagnostic Strategies

Leslee J. Shaw, PhD^_*,_*, C. Noel Bairey Merz, MD^_*, Carl J. Pepine, MD, Steven E. Reis, MD, Vera Bittner, MD^_**, Sheryl F. Kelsey, PhD, Marian Olson, MS, B. Delia Johnson, PhD, Sunil Mankad, MD^||, Barry L. Sharaf, MD^¶, William J. Rogers, MD^_**, Timothy R. Wessel, MD, Christopher B. Arant, MD, Gerald M. Pohost, MD, Amir Lerman, MD, Arshed A. Quyyumi, MD, 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 September 28, 2004; revised manuscript received December 7, 2004, accepted January 4, 2005.

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

Despite a dramatic decline in mortality over the past three decades, coronary heart disease is the leading cause of death and disability in the U.S. Importantly, recent advances in the field of cardiovascular medicine have not led to significant declines in case fatality rates for women when compared to the dramatic declines realized for men. The current review highlights gender-specific issues in ischemic heart disease presentation, evaluation, and outcomes with a special focus on the results published from the National Institutes of Health-National Heart, Lung, and Blood Institute-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study. We will present recent evidence on traditional and novel risk markers (e.g., high sensitivity C-reactive protein) as well as gender-specific differences in symptoms and diagnostic approaches. An overview of currently available diagnostic test evidence (including exercise electrocardiography and stress echocardiography and single-photon emission computed tomographic imaging) in symptomatic women will be presented as well as data using innovative imaging techniques such as magnetic resonance subendocardial perfusion, and spectroscopic imaging will also be discussed.

Abbreviations and Acronyms   CAD = coronary artery disease   CDC = Centers for Disease Control   CI = confidence interval   DASI = Duke Activity Status Index   FRS = Framingham risk score   HDL = high-density lipoprotein   hsCRP = high sensitivity C-reactive protein   IHD = ischemic heart disease   LDL = low-density lipoprotein   METs = metabolic equivalents   MR = magnetic resonance   PCr/ATP = phosphocreatine/adenosine triphosphate   SPECT = single-photon emission computed tomography   WISE = Women’s Ischemia Syndrome Evaluation

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