Stable angina in women: lessons from the National Heart, Lung and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation

The paradoxical sex difference in which women have lower rates of anatomical coronary artery disease (CAD) but worsening symptoms, ischemia, and outcomes appears to be linked to a sex-specific pathophysiology of coronary reactivity, which includes microvascular dysfunction. For women with obstructive CAD, their risk is elevated compared with men, yet women are less likely to receive guideline-indicated therapies. For women with evidence of ischemia but no obstructive CAD, antianginal and antiischemic therapies can ameliorate symptoms, improve endothelial function and quality of life; however, trials aimed to improve outcomes are needed. Thus, ischemic heart disease (IHD) in women presents a unique and difficult challenge for clinicians due to a greater symptom burden, functional disability, higher healthcare costs, and more adverse outcomes as compared with men, despite a lower prevalence and severity of obstructive CAD, which remains the current focus of therapeutic strategies. Continued research is indicated to devise therapeutic regimens to improve symptom burden and reduce risk in women with IHD. J Cardiovasc Med 12:85-87 (C) 2011 Italian Federation of Cardiology.