26 Feb Women With Ischemia but No Obstructive CAD Remain at Risk of Major Adverse Cardiovascular Events

MedicalResearch.com Interview with:

Dr. Aldiwani

Haider Aldiwani, MD
Fellow in Internal Medicine

and

Dr. Bairey Merz

C. Noel Bairey Merz, MD, FACC, FAHA
Director

Barbra Streisand Women’s Heart Center
Smidt Heart Institute, Cedars-Sinai Medical Center
Los Angeles, CA, 90048

MedicalResearch.com: What is the background for this study?

Response: Cardiovascular disease is the leading cause of death in women in the United States. Women are found to have a higher prevalence of ischemia but no obstructive coronary artery disease (INOCA) compared to men. These women are often labeled as “normal” and their symptoms and cardiovascular risk are not managed appropriately. Women with INOCA are higher risk of developing major adverse cardiovascular events including death, myocardial infarction (MI), stroke and heart failure hospitalization. Presenting symptoms of ischemia are variable and more often labelled “atypical” in women. 

MedicalResearch.com: What are the main findings?

Response: There are few studies that previously addressed patient symptoms over time but none to the best of our knowledge addressed angina symptoms in women with ischemia but no obstructive coronary artery disease specifically. We followed 551 women with INOCA enrolled in the National Heart, Lung, and Blood Institute–sponsored WISE study for a maximum of 9 years. Women with INOCA continued to be hospitalized for angina with consistent rates despite advances in medical diagnostics and therapies.

Women using angiotensin converting enzyme inhibitors, statins, nitroglycerin and found to have non-obstructive coronary artery disease were at greater risk for angina hospitalization. Our findings suggest that these women may have a higher disease burden of atherosclerosis and or coronary microvascular dysfunction.

MedicalResearch.com: What should readers take away from your report? 

1. Women with signs and symptoms of INOCA are often admitted for angina and are at risk for major adverse cardiovascular events. We observed that hospitalization rates did not decline over time despite improved diagnostic and therapeutic strategies.

2.Education of patients and healthcare providers regarding INOCA is needed.

3.Women with INOCA should not be labelled “normal” and reassured.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: More clinical trials aiming to reduce angina hospitalization rates are needed and to identify the pathophysiological mechanisms contributing to angina symptoms in women with no CAD and women with no obstructive CAD.

Disclosures: No disclosures for this topic except that this research was supported by the National Heart, Lung and Blood Institute.

Citation:

Angina Hospitalization Rates in Women With Signs and Symptoms of Ischemia But no Obstructive Coronary Artery Disease: A Report from the WISE (Women’s Ischemia Syndrome Evaluation) Study

Haider Aldiwani, Melody Zaya,  Nissi Suppogu, Odayme Quesada, B. Delia Johnson, Puja K. Mehta, Chrisandra Shufelt, John Petersen, Babak Azarbal, Bruce Samuels et al
Originally published17 Feb 2020
https://doi.org/10.1161/JAHA.119.013168
Journal of the American Heart Association. 2020;9:e013168 

Last Modified: [last-modified] 

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Last Updated on February 26, 2020 by Marie Benz MD FAAD