Nonobstructive Coronary Artery Disease in Women

Pepine CJ, Ferdinand KC, Shaw LJ, et al.
Emergence of Nonobstructive Coronary Artery Disease: A Woman’s Problem and Need for Change in Definition on Angiography. J Am Coll Cardiol 2015;66:1918-1933.

The following are key points about nonobstructive coronary artery disease in women:

  1. The nonobstructive CAD is more common among women than men. Emerging data suggest that nonobstructive CAD is associated with increased risk for cardiovascular disease events compared to normal subjects.
  2. Ischemic signs and symptoms in patients with nonobstructive CAD are associated with coronary endothelial and microvascular dysfunction. Differing definitions of nonobstructive CAD have limited current understanding and management of nonobstructive CAD. Since coronary microvascular and/or endothelial dysfunction is associated with increased vascular events, improving current management is warranted.
  3. Direct measures of coronary blood flow reserve with intravascular ultrasound (IVUS) or positron emission tomography (PET) and/or cardiomyocyte metabolism (cardiac magnetic resonance imaging) may be preferable to assessment of ischemia in patients with nonobstructive CAD than other types of ischemic assessment. Research related to diagnosis and assessment is needed.
  4. Differences have been observed for vascular function and physiology among women and men. Gender differences in interstitial fibrosis and perivascular fibroses have been observed.
  5. Data from clinical studies including 10 years of follow-up from the WISE (Women's Ischemic Syndrome Evaluation) study suggest that women with nonobstructive CAD are at significantly increased risk for cardiovascular disease events compared to normal subjects. Prevalence of hypertension is high among women and may alert clinicians to an increased risk for ischemic heart disease in women. Additionally, risk factors including pre-diabetes mellitus and diabetes mellitus increase a woman’s risk for events even with nonobstructive CAD.

Clinical Topics: Acute Coronary Syndromes, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Prevention, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Interventions and ACS, Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Computed Tomography, Echocardiography/Ultrasound, Magnetic Resonance Imaging, Nuclear Imaging, Hypertension, Chronic Angina

Keywords: Acute Coronary Syndrome, Angina, Stable, Angiography, Coronary Artery Disease, Diabetes Mellitus, Hypertension, Magnetic Resonance Imaging, Myocardial Ischemia, Positron-Emission Tomography, Secondary Prevention, Risk Factors, Ultrasonography, Interventional, Women

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