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VIEWPOINT

Women and Cardiovascular Heart Disease: Clinical Implications From the Women’s Ischemia Syndrome Evaluation (WISE) Study

Are We Smarter?

Amir Lerman, MD, FACC^_*,_* and George Sopko, MD, MPH

^_* Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota
Division of Heart and Vascular Disease, National Heart, Lung, and Blood Institute, Bethesda, Maryland

Manuscript received October 12, 2004; revised manuscript received October 22, 2004, accepted October 25, 2004.

^_* Reprint requests and correspondence: Dr. Amir Lerman, Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, 200 First Street SW, Rochester, Minnesota 55902 (Email: lerman.amir{at}mayo.edu).

Review of the trend in cardiovascular disease mortality for males and females clearly demonstrated that whereas the trend shows a decline in males this decline is not observed in females. Multiple important reports emerged from the initial phases of the Women’s Ischemic Syndrome Evaluation (WISE) study that may have significant clinical implications for our approach to cardiovascular disease in women. The data derived from the WISE study certainly provided important information to our understanding of the approach to women with cardiovascular disease. The clinical presentation may be different, and a gender-oriented questionnaire may enhance our diagnosis. In a multivariable model, low hemoglobin was associated with significantly higher risk of adverse outcomes. The risk factor assessment and the risk factor profiles in women that are associated with coronary artery disease may be different. Based on the studies from the WISE study, metabolic syndrome is a leading and a major risk factor in women. Moreover, the data further support the concept that the mechanism of ischemia in women may be localized in the microvascular coronary arteries. Therefore, the diagnoses of coronary microvascular dysfunction or endothelial dysfunction should be considered in women with chest pain who do not have obstructive coronary artery disease. It may be advantageous to add such diagnostic tests when the conventional tests are nondiagnostic. A revised clinical approach to cardiovascular disease in women may be designed and tested based on these findings.

Abbreviations and Acronyms   BMI = body mass index   CAD = coronary artery disease   CASS = Coronary Artery Surgery Study   CHD = coronary heart disease   Hgb = hemoglobin   IHD = ischemic heart disease   NHLBI = National Heart, Lung, and Blood Institute   WISE = Women’s Ischemia Syndrome Evaluation

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