Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, U.S.A.
Clin Sci (Lond). 2018 Sep 5;132(17):1937-1952. doi: 10.1042/CS20180067. Print 2018 Sep 14.
The recognition of sex differences in cardiovascular disease, particularly the manifestations of coronary artery disease (CAD) in post-menopausal women, has introduced new challenges in not only understanding disease mechanisms but also identifying appropriate clinical means of assessing the efficacy of management strategies. For example, the majority of treatment algorithms for CAD are derived from the study of males, focus on epicardial stenoses, and inadequately account for the small intramyocardial vessel disease in women. However, newer investigational modalities, including stress perfusion cardiac magnetic resonance imaging and positron emission tomography are providing enhanced diagnostic accuracy and prognostication for women with microvascular disease. Moreover, these investigations may soon be complemented by simpler screening tools such as retinal vasculature imaging, as well as novel biomarkers (e.g. heat shock protein 27). Hence, it is vital that robust, sex-specific cardiovascular imaging modalities and biomarkers continue to be developed and are incorporated into practice guidelines that are used to manage women with CAD, as well as gauge the efficacy of any new treatment modalities. This review provides an overview of some of the sex differences in CAD and highlights emerging advances in the investigation of CAD in post-menopausal women.
心血管疾病中性别差异的认识，特别是绝经后女性冠心病（CAD）的表现，不仅在理解疾病机制方面带来了新的挑战，而且在确定评估管理策略疗效的适当临床手段方面也带来了新的挑战。例如，CAD 的大多数治疗算法都源自男性研究，侧重于心外膜狭窄，并且不能充分考虑女性的心肌内小血管疾病。然而，包括应激灌注心脏磁共振成像和正电子发射断层扫描在内的新型研究方法正在为患有微血管疾病的女性提供增强的诊断准确性和预后。此外，这些研究可能很快会得到视网膜血管成像等更简单的筛查工具以及新型生物标志物（例如热休克蛋白 27）的补充。因此，至关重要的是，要继续开发强大的、特定于性别的心血管成像方式和生物标志物，并将其纳入用于管理 CAD 女性以及评估任何新治疗方法疗效的实践指南中。这篇综述概述了 CAD 中的一些性别差异，并强调了绝经后女性 CAD 研究中的新进展。
