Lerman Amir, Sopko George
Division of Cardiovascular Disease and Department of Internal Medicine, Mayo College of Medicine, Rochester, Minnesota 55902, USA.
J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S59-62. doi: 10.1016/j.jacc.2004.10.083.
Review of the trend in cardiovascular disease mortality for males and females clearly demonstrated that whereas the trend shows a decline in males this decline is not observed in females. Multiple important reports emerged from the initial phases of the Women's Ischemic Syndrome Evaluation (WISE) study that may have significant clinical implications for our approach to cardiovascular disease in women. The data derived from the WISE study certainly provided important information to our understanding of the approach to women with cardiovascular disease. The clinical presentation may be different, and a gender-oriented questionnaire may enhance our diagnosis. In a multivariable model, low hemoglobin was associated with significantly higher risk of adverse outcomes. The risk factor assessment and the risk factor profiles in women that are associated with coronary artery disease may be different. Based on the studies from the WISE study, metabolic syndrome is a leading and a major risk factor in women. Moreover, the data further support the concept that the mechanism of ischemia in women may be localized in the microvascular coronary arteries. Therefore, the diagnoses of coronary microvascular dysfunction or endothelial dysfunction should be considered in women with chest pain who do not have obstructive coronary artery disease. It may be advantageous to add such diagnostic tests when the conventional tests are nondiagnostic. A revised clinical approach to cardiovascular disease in women may be designed and tested based on these findings.
对男性和女性心血管疾病死亡率趋势的回顾清楚地表明，虽然男性的趋势呈下降，但女性却未观察到这种下降。女性缺血综合征评估（WISE）研究的初始阶段出现了多篇重要报告，这些报告可能对我们处理女性心血管疾病的方法具有重大临床意义。WISE研究得出的数据无疑为我们理解女性心血管疾病的处理方法提供了重要信息。临床表现可能不同，一份针对性别的问卷可能会提高我们的诊断水平。在一个多变量模型中，低血红蛋白与不良结局的风险显著升高相关。与冠状动脉疾病相关的女性风险因素评估和风险因素概况可能不同。基于WISE研究的各项研究，代谢综合征是女性的主要风险因素。此外，数据进一步支持了女性缺血机制可能局限于冠状动脉微血管的概念。因此，对于没有阻塞性冠状动脉疾病的胸痛女性，应考虑诊断为冠状动脉微血管功能障碍或内皮功能障碍。当传统检查无法诊断时，增加此类诊断检查可能会有帮助。基于这些发现，可以设计并测试一种针对女性心血管疾病的修订临床方法。
