Brewer LaPrincess C, Svatikova Anna, Mulvagh Sharon L
Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Cardiovasc Drugs Ther. 2015 Aug;29(4):355-68. doi: 10.1007/s10557-015-6607-4.
Increasing evidence suggests that there are significant differences in the presentation, diagnosis and treatment of ischemic heart disease in women compared to men. Women often present with atypical symptoms, and this, in association with a consistent underestimation of their risk for ischemic heart disease, leads to underdiagnosis and undertreatment in women. Cardiovascular risk factors unique to women have only recently been recognized, and moreover, traditional risk factors have recently been shown to have greater impacts on women. Consequently, women suffer more disability and poorer clinical outcomes, with higher cardiovascular morbidity and mortality. These discrepancies may in part be secondary to the higher prevalence of nonobstructive coronary artery disease in women with persistent chest pain symptoms as compared to men when evaluated invasively. Focused diagnostic and therapeutic strategies unique to women are thus needed, but unfortunately, such sex-specific guidelines do not yet exist, largely due to lack of awareness, both on the part of providers and patients, as well as a paucity of evidence-based research specific to women. Although underutilized in women, diagnostic modalities, including functional and anatomic cardiac tests as well as physiologic assessments of endothelial and microvascular function, are useful for establishing the diagnosis and prognosis of suspected ischemic heart disease in women. This review discusses the current challenges of prevention, diagnosis and treatment of ischemic heart disease in women.
越来越多的证据表明，与男性相比，女性缺血性心脏病在表现、诊断和治疗方面存在显著差异。女性常表现出非典型症状，再加上一直以来对她们患缺血性心脏病风险的低估，导致女性的诊断不足和治疗不足。女性特有的心血管危险因素直到最近才被认识到，此外，传统危险因素最近也被证明对女性有更大影响。因此，女性遭受更多残疾，临床结局更差，心血管发病率和死亡率更高。这些差异部分可能是由于在有持续性胸痛症状的女性中，与男性相比，经侵入性评估时非阻塞性冠状动脉疾病的患病率更高。因此，需要针对女性的有针对性的诊断和治疗策略，但不幸的是，这种针对性别的指南尚不存在，这主要是由于医疗服务提供者和患者双方缺乏认识，以及缺乏针对女性的循证研究。尽管在女性中未得到充分利用，但包括心脏功能和解剖检查以及内皮和微血管功能的生理评估在内的诊断方法，对于确定女性疑似缺血性心脏病的诊断和预后很有用。本综述讨论了女性缺血性心脏病预防、诊断和治疗方面的当前挑战。
