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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.

View larger version (38K): [in a new window]   Figure 1 Forest plot of the summary relative risk for major adverse cardiac events in women with coronary or peripheral endothelial dysfunction. The summary relative risk ratio is elevated 11.1- and 10.0-fold for evidence of coronary and peripheral endothelial dysfunction. CI = confidence interval.

View larger version (124K): [in a new window]   Figure 2 An example of plaque erosion, the typical presentation for sudden cardiac death in younger women. This example reveals an eccentric plaque with subocclusive thrombus in multiple views and sections (a to d) in a 58-year-old female smoker. Reproduced with permission (75).

View larger version (19K): [in a new window]   Figure 3 This graph shows the annual rate of first myocardial infarction (MI) by gender noting the significantly higher rate across all age groups in men as compared with women. Despite the differences in the rate of myocardial infarction by gender, post-infarction mortality is elevated significantly in younger women. In an adaptation of the result from Vaccarino et al. (18), the odds ratio was elevated approximately two-fold for women in the 35-to-44-year range and elevated 1.6-fold for women in the 45-to-54-year range.