Blum Arnon, Blum Nava
Department of Internal Medicine, Baruch-Padeh Poria Medical Center, Lower Galilee, Israel.
Gend Med. 2009 Sep;6(3):410-8. doi: 10.1016/j.genm.2009.09.005.
Ischemic heart disease in women is a difficult issue in cardiovascular medicine, mainly because of our lack of understanding of the early-stage mechanisms and symptoms. A better and earlier understanding of the pathophysiology of coronary artery disease (CAD) in women will enable us to detect ischemic heart disease earlier and prevent adverse clinical outcomes.
The aims of this article were to describe the phenomenon of ischemic heart disease in women, increase awareness of the difference between men and women in relation to ischemic heart disease, improve our understanding of the mechanisms that cause this difference, and identify new approaches for better and earlier detection and treatment of CAD in women.
We conducted a search of the PubMed database for double-blind studies on the mechanistic pathways of CAD in women published in English within the past 10 years and epidemiologic studies published since 1970. Search terms included women and coronary artery disease and ischemic heart disease in women.
The literature search revealed 30 peer-reviewed articles pertaining to this issue. The incidence of CAD was markedly lower in women <60 years of age than in older women. After 60 years of age, the rate of CAD increased and reached the rate seen among men by the 8th decade of life. The gender difference in atherosclerosis in the coronary tree was particularly large in patients <55 years of age and remained large at older ages. The gender difference in the coronary bed was strikingly larger than in other vascular beds. Intensive risk-factor modification had a similar effect on plaque progression in both men and women. Coronary endothelial dysfunction appeared to be related to cardiovascular morbidity and mortality in women as well as in men, and because endothelial dysfunction could be modified, it appeared that the prognosis could be improved by appropriate management. A strong association was found between body mass index (BMI) and metabolic status, but only the metabolic syndrome was associated with CAD. Physical activity was independently associated with fewer risk factors, less CAD, and fewer adverse events in women; however, obesity was not associated with these outcomes.
Results of the identified studies suggest that reduction of risk factors is a common approach to fighting heart disease in both sexes. It appears that for women, weight and BMI are not as important as previously thought, but physical exercise and fitness are very important and can change risk factors and clinical outcomes more than any other known intervention. Data suggest that global inflammation may play an important role in women and may predict cardiovascular outcome in women much better than the traditional risk factors that have been used and proved for men.
女性缺血性心脏病是心血管医学中的一个难题，主要是因为我们对其早期机制和症状缺乏了解。更好、更早地了解女性冠状动脉疾病（CAD）的病理生理学，将使我们能够更早地检测出缺血性心脏病，并预防不良临床结局。
本文旨在描述女性缺血性心脏病的现象，提高对缺血性心脏病男女差异的认识，增进我们对造成这种差异机制的理解，并确定更好、更早地检测和治疗女性CAD的新方法。
我们在PubMed数据库中检索了过去10年内以英文发表的关于女性CAD机制途径的双盲研究以及自1970年以来发表的流行病学研究。检索词包括女性、冠状动脉疾病和女性缺血性心脏病。
文献检索发现了30篇关于该问题的同行评审文章。60岁以下女性的CAD发病率明显低于老年女性。60岁以后，CAD发病率上升，到80岁时达到男性的发病率。在55岁以下的患者中，冠状动脉粥样硬化的性别差异尤为明显，在老年时仍然很大。冠状动脉床的性别差异明显大于其他血管床。强化风险因素修正对男性和女性斑块进展的影响相似。冠状动脉内皮功能障碍似乎与男性和女性的心血管发病率和死亡率都有关，而且由于内皮功能障碍可以得到改善，似乎通过适当的管理可以改善预后。发现体重指数（BMI）与代谢状态之间存在密切关联，但只有代谢综合征与CAD有关。体力活动与女性较少的风险因素、较少的CAD和较少的不良事件独立相关；然而，肥胖与这些结果无关。
已确定研究的结果表明，降低风险因素是两性防治心脏病的常用方法。似乎对女性来说，体重和BMI并不像以前认为的那么重要，但体育锻炼和健康状况非常重要，而且比任何其他已知干预措施更能改变风险因素和临床结局。数据表明，全身性炎症可能在女性中起重要作用，并且可能比已用于男性并得到验证的传统风险因素更能预测女性的心血管结局。
