Madika Anne-Laure, Devos Patrick, Delsart Pascal, Boudghène Fanny, Polge Anne-Sophie, Bauters Christophe, Mounier-Vehier Claire
CHU Lille, Institut Cardio-Pulmonaire, Lille, France.
Université Lille, CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Lille, France.
Arch Cardiovasc Dis. 2017 Jun-Jul;110(6-7):379-388. doi: 10.1016/j.acvd.2016.10.006. Epub 2017 Feb 22.
Cardiovascular disease is the primary cause of death in women. Prevention, screening and diagnosis are generally implemented at later stages and less frequently than in men, and provision of treatment is not optimal in women.
To assess the relevance of targeted screening for myocardial ischaemia in women with multiple risk factors, and to identify which specific factors target women more effectively.
We undertook a prospective observational study with retrospective data collection based on a cohort of symptomatic or asymptomatic women with multiple cardiovascular risk factors. All women underwent non-invasive diagnostic testing through the "Heart, arteries and women", healthcare pathway available at Lille University Hospital, between 1 January 2013 and 30 June 2014.
Screening was positive in 15.7% of the 287 participants. Thirty women had a coronary angiography: of these, 22 (73.3%) had no evidence of obstructive coronary artery disease. The independent predictive factors for positive screening were >5 years since menopause (odds ratio [OR] 3.9; P=0.0016); high-density lipoprotein cholesterol ≤0.5g/dL (OR 2.3; P=0.0356); and body mass index ≥30kg/m (OR 3.7; P=0.0009). Symptoms were predictive of positive screening (P=0.010), but were mostly atypical. Based on these observations, we developed a clinical coronary score to target screening more efficiently (area under the curve 0.733). Positive screening resulted in low rates of revascularization (16.6%), but a significant increase in the prescription of statins (P=0.002), antiplatelet agents (P<0.0001) and beta-blockers (P=0.024).
Screening for myocardial ischaemia among selected women at risk of cardiovascular disease can be useful to improve medical treatment.
心血管疾病是女性死亡的主要原因。与男性相比，预防、筛查和诊断通常在较晚阶段实施且频率较低，并且女性的治疗提供并不理想。
评估针对具有多种危险因素的女性进行心肌缺血靶向筛查的相关性，并确定哪些特定因素能更有效地针对女性。
我们基于一组有症状或无症状的具有多种心血管危险因素的女性队列进行了一项前瞻性观察研究，并进行回顾性数据收集。2013年1月1日至2014年6月30日期间，所有女性均通过里尔大学医院提供的“心脏、动脉与女性”医疗途径接受了非侵入性诊断检测。
287名参与者中有15.7%的筛查呈阳性。30名女性进行了冠状动脉造影：其中22名（73.3%）没有阻塞性冠状动脉疾病的证据。筛查呈阳性的独立预测因素为绝经后超过5年（优势比[OR] 3.9；P = 0.0016）；高密度脂蛋白胆固醇≤0.5g/dL（OR 2.3；P = 0.0356）；以及体重指数≥30kg/m²（OR 3.7；P = 0.0009）。症状可预测筛查呈阳性（P = 0.010），但大多是非典型的。基于这些观察结果，我们制定了一个临床冠状动脉评分以更有效地进行靶向筛查（曲线下面积为0.733）。筛查呈阳性导致血管重建率较低（16.6%），但他汀类药物（P = 0.002）、抗血小板药物（P < 0.0001）和β受体阻滞剂（P = 0.024）的处方显著增加。
对选定的有心血管疾病风险的女性进行心肌缺血筛查可能有助于改善医疗治疗。
