Journal
AMERICAN HEART JOURNAL
Volume 162, Issue 4, Pages 678-684Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ahj.2011.07.011
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Funding
- National Heart, Lung and Blood Institute [N01-HV-68161, N01-HV-68162, N01-HV-68163, N01-HV-68164]
- National Center for Research Resources [MO1-RR00425]
- Gustavus and Louis Pfeiffer Research Foundation, Denville, New Jersey
- Women's Guild of Cedars-Sinai Medical Center, Los Angeles, California
- Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh, Pennsylvania
- Pfizer Labs
- Edythe L. Broad Endowment for Women's Heart Research, Los Angeles, California
- Eminent Scholar Research Chair, AHA Suncoast Chapter
- NIH/NHLBI [5 U01 HL087366-04, 5 R01 HL091005-03, 5 R01 HL090957-03, 2 U01 GM074492-06]
- NIH/AG [3 U01 AG022376-05A2S1]
- NIH/NCRR [5 UL1 RR029890-02]
- [U0164829]
- [U01 HL649141]
- [U01 HL649241]
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Background We investigated the role of the renin-angiotensin system in women with signs and symptoms of ischemia without obstructive coronary artery disease (CAD). Although microvascular dysfunction has been suggested to explain this syndrome and recently was found to predict adverse outcomes, the mechanisms and treatments remain unclear. Methods In a substudy within the WISE, 78 women with microvascular dysfunction (coronary flow reserve [CFR] <3.0 following adenosine) and no obstructive CAD were randomly assigned to either an angiotensin-converting enzyme inhibition (ACE-I) with quinapril or a placebo treatment group. The primary efficacy parameter was CFR at 16 weeks adjusted for baseline characteristics and clinical site. The secondary response variable was freedom from angina symptoms assessed using the Seattle Angina Questionnaire. Results A total of 61 women completed the 16-week treatment period with repeat CFR measurements, and treatment was well tolerated. For the primary outcome, at 16 weeks, CFR improved more with ACE-I than placebo (P < .02). For the secondary outcome of symptom improvement, ACE-I treatment (P = .037) and CFR increase (P = .008) both contributed. Conclusions Microvascular function improves with ACE-I therapy in women with signs and symptoms of ischemia without obstructive CAD. This improvement is associated with reduction in angina. The beneficial response of the coronary microvasculature was limited to women with lower baseline CFR values, suggesting that the renin-angiotensin system may be more involved among women with more severe microvascular defects. (Am Heart J 2011;162:678-84.)
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