DonaldW. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
JACC Cardiovasc Imaging. 2011 Jan;4(1):65-73. doi: 10.1016/j.jcmg.2010.10.006.
we sought to evaluate the relationship between angina and coronary artery calcium (CAC) in women, and among women without CAC, the associations between angina and clinical, vascular, and inflammatory factors.
angina in women without coronary atherosclerosis is associated with significant morbidity, yet its determinants are poorly understood.
women ages 30 to 65 years from the Dallas Heart Study, a multiethnic probability sample of Dallas County residents, who completed a Rose angina questionnaire and had complete data for CAC by computed tomography were selected for this analysis. Soluble intercellular adhesion molecule-1, soluble vascular cell adhesion molecule-1, high sensitivity C-reactive protein, monocyte chemoattractant protein-1 and aortic compliance by magnetic resonance imaging were measured.
among the 1,480 women in this cohort (mean age 45 years, 49% African-American), angina was present in 6.9% but was not associated with CAC (19% CAC prevalence with angina vs. 15% without, p = 0.2). Among women without CAC, angina was related to variables reflecting obesity and insulin resistance and was independently associated with African-American ethnicity, premature family history of myocardial infarction, and waist circumference (all p < 0.05). Such women with angina also had higher levels of soluble intercellular adhesion molecule-1 (668 vs. 592 ng/ml, p = 0.02) and soluble vascular cell adhesion molecule-1 (1,106 vs. 968 ng/ml, p = 0.01) and reduced aortic compliance (mean 22 vs. 26 ml/mm Hg, p = 0.007) than such women without angina. Conversely, there was no difference in C-reactive protein or monocyte chemoattractant protein-1 levels for women with and without angina (p = not significant, each).
angina among women in the general population is common and is not associated with subclinical atherosclerosis. Additionally, angina in the absence of subclinical atherosclerosis is not related to many traditional atherosclerotic risk factors but is associated with clinical, inflammatory, and vascular factors that reflect endothelial dysfunction and vascular stiffness, suggesting a distinct vascular etiology and alternative potential therapeutic targets.
本研究旨在评估女性心绞痛与冠状动脉钙（CAC）之间的关系，并在无 CAC 的女性中，评估心绞痛与临床、血管和炎症因素之间的相关性。
在无冠状动脉粥样硬化的女性中，心绞痛与较高的发病率相关，但发病机制尚不清楚。
本研究选取达拉斯心脏研究中的女性，该研究为达拉斯县居民的多民族概率抽样，年龄 30 至 65 岁，完成了 Rose 心绞痛问卷，并通过计算机断层扫描完成了 CAC 的完整数据。测量可溶性细胞间黏附分子-1、可溶性血管细胞黏附分子-1、高敏 C 反应蛋白、单核细胞趋化蛋白-1和磁共振成像的主动脉顺应性。
在本队列中的 1480 名女性（平均年龄 45 岁，49%为非裔美国人）中，6.9%存在心绞痛，但与 CAC 无关（心绞痛患者的 CAC 患病率为 19%，无心绞痛患者的 CAC 患病率为 15%，p = 0.2）。在无 CAC 的女性中，心绞痛与反映肥胖和胰岛素抵抗的变量相关，与非裔美国人种族、早发家族性心肌梗死史和腰围相关（均 p < 0.05）。这些有胸痛的女性，其可溶性细胞间黏附分子-1（668 vs. 592ng/ml，p = 0.02）和可溶性血管细胞黏附分子-1（1106 vs. 968ng/ml，p = 0.01）水平更高，主动脉顺应性更低（平均 22 vs. 26ml/mm Hg，p = 0.007）。相反，有胸痛和无胸痛的女性之间 C 反应蛋白或单核细胞趋化蛋白-1水平无差异（p = 无显著差异，各指标）。
在一般人群中，女性心绞痛较为常见，与亚临床动脉粥样硬化无关。此外，在无亚临床动脉粥样硬化的情况下，心绞痛与许多传统的动脉粥样硬化危险因素无关，但与反映内皮功能障碍和血管僵硬的临床、炎症和血管因素相关，这提示了不同的血管病因和潜在的替代治疗靶点。
