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International Journal of Clinical Research & Trials Volume 5 (2020), Article ID 5:IJCRT-152, 6 pages
https://doi.org/10.15344/2456-8007/2020/152
Review Article
Non-Obstructive Coronary Artery Disease in Women: Current Evidence and Future Directions

Leanna R. Smith, Moro O. Salifu and Isabel M. McFarlane*

Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA
Dr. Isabel M. McFarlane, Department of Internal Medicine, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA, Tel: 718-270-2390, Fax: 718-270-1324; E-mail: Isabel.McFarlane@downstate.edu
10 October 2020; 22 November 2020; 24 November 2020
Smith LR, Salifu MO, McFarlane IM (2020) Non-Obstructive Coronary Artery Disease in Women: Current Evidence and Future Directions. Int J Clin Res Trials 5: 152. doi: https://doi.org/10.15344/2456-8007/2020/152

References

  1. BaireyMerz CN, Pepine CJ, Walsh MN, Fleg JL (2017) Ischemia and no obstructive coronary artery disease (INOCA): developing evidence-based therapies and research agenda for the next decade. Circulation 135: 1075-1092. [CrossRef] [Google Scholar] [PubMed]
  2. Kenkre TS, Malhotra P, Johnson BD, Handberg EH, Thompson DV, et al. (2017) Ten-Year Mortality in the WISE Study (Women’s Ischemia Syndrome Evaluation). Circ Cardiovasc Qual Outcomes 10: e003863. [CrossRef] [Google Scholar] [PubMed]
  3. Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, et al. (2012) Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 33: 734-744. [CrossRef] [Google Scholar] [PubMed]
  4. Camici PG, Crea F (2007) Coronary microvascular dysfunction. N Engl J Med 356: 830-840. [CrossRef] [Google Scholar] [PubMed]
  5. Kothawade K, BaireyMerz CN (2011) Microvascular coronary dysfunction in women: pathophysiology, diagnosis, and management. Curr Probl Cardiol 36: 291-318. [CrossRef] [Google Scholar] [PubMed]
  6. Pepine CJ, Anderson RD, Sharaf BL, Reis SE, Smith KM, et al. (2010) Coronary microvascular reactivity to adenosine predicts adverse outcome in women evaluated for suspected ischemia: Results from the National Heart, Lung and Blood Institute WISE (Women’s Ischemia Syndrome Evaluation) study. J Am Coll Cardiol 55: 2825-2832. [CrossRef] [Google Scholar] [PubMed]
  7. Sharaf BL, Pepine CJ, Kerensky RA, Reis SE, Reichek N, et al. (2001) Detailed angiographic analysis of women with suspected ischemic chest pain (pilot phase data from the NHLBI-sponsored Women's Ischemia Syndrome Evaluation [WISE] Study Angiographic Core Laboratory). Am J Cardiol 87: 937-941. [CrossRef] [Google Scholar] [PubMed]
  8. Chen C, Wei J, AlBadri A, Zarrini P, Merz NB, et al. (2017) Coronary Microvascular Dysfunction - Epidemiology, Pathogenesis, Prognosis, Diagnosis, Risk Factors and Therapy. Circ J 81: 3-11. [CrossRef] [Google Scholar] [PubMed]
  9. Kuo L, Davis MJ, Chilian WM (1995) Longitudinal gradients for endothelium-dependent and -independent vascular responses in the coronary microcirculation. Circulation 92: 518-525. [CrossRef] [Google Scholar]
  10. Ohman EM (2016) Chronic stable angina. N Engl J Med 375: 293. [CrossRef] [Google Scholar]
  11. Kemp HG Jr, Vokonas PS, Cohn PF, Gorlin R (1973) The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience. Am J Med 54: 735-742. [CrossRef] [Google Scholar] [PubMed]
  12. Cannon RO 3rd, Epstein SE (1988) Microvascular “angina" as a cause of chest pain with angiographically normal coronary arteries. Am J Cardiol 61: 1338-1343. [CrossRef] [Google Scholar] [PubMed]
  13. Kaski JC, Crea F, Nihoyannopoulos P, Hackett D, Maseri A, et al. (1986) Transient myocardial ischemia during daily life in patients with syndrome. Am J Cardiol 58: 1242-1247. [CrossRef] [Google Scholar] [PubMed]
  14. Sullivan AK, Holdright DR, Wright CA, Sparrow JL, Cunningham D, et al. (1994) Chest pain in women: clinical, investigative, and prognostic features. BMJ 308: 883-886. [CrossRef] [Google Scholar] [PubMed]
  15. Pasceri V, Lanza GA, Buffon A, Montenero AS, Crea F, et al. (1998) Role of abnormal pain sensitivity and behavioral factors in determining chest pain in syndrome. J Am CollCardiol 31: 62-66. [CrossRef] [Google Scholar] [PubMed]
  16. Kothawade K, Merz CNB (2011) Microvascular Coronary Dysfunction in Women - Pathophysiology, Diagnosis, and Management. Curr Probl Cardiol 36: 291-318. [CrossRef] [Google Scholar] [PubMed]
  17. Crea F, Lanza GA (2004) Angina pectoris and normal coronary arteries: cardiac syndrome. Heart 90: 457-463. [CrossRef] [Google Scholar]
  18. Gutiérrez E, Flammer AJ, Lerman LO, Elízaga J, Lerman A, et al. (2013) Endothelial dysfunction over the course of coronary artery disease. Eur Heart J 34: 3175-3181. [CrossRef] [Google Scholar] [PubMed]
  19. Jespersen L, Hvelplund A, Abildstrøm SZ, Pedersen F, Galatius S, et al. (2012) Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events. Eur Heart J 33: 734-744. [CrossRef] [Google Scholar] [PubMed]
  20. Halcox JP, Schenke WH, Zalos G, Mincemoyer R, Prasad A, et al. (2002) Prognostic value of coronary vascular endothelial dysfunction. Circulation 106: 653-658. [CrossRef] [Google Scholar] [PubMed]
  21. Sodha NR, Boodhwani M, Clements RT, Feng J, Xu SH, et al. (2008) Coronary microvascular dysfunction in the setting of chronic ischemia is independent of arginase activity. Microvasc Res 75: 238-246. [CrossRef] [Google Scholar]
  22. Bugiardini R, Badimon L, Collins P, Erbel R, Fox K, et al. (2007) Angina, "normal" coronary angiography, and vascular dysfunction: risk assessment strategies. PLoS Med 4: e12. [CrossRef] [Google Scholar] [PubMed]
  23. Kaski JC, Elliott PM, Salomone O, Dickinson K, Gordon D, et al. Concentration of circulating plasma endothelin in patients with angina and normal coronary angiograms. Br Heart J 74: 620-624. [CrossRef] [Google Scholar] [PubMed]
  24. Hess OM, Büchi M, Kirkeeide R, Niederer P, Anliker M, et al. (1990) Potential role of coronary vasoconstriction in ischaemic heart disease: effect of exercise. Eur Heart J. 11: 58-64. [CrossRef] [Google Scholar] [PubMed]
  25. Nabel EG, Ganz P, Gordon JB, Alexander RW, Selwyn AP, et al. (1988) Dilation of normal and constriction of atherosclerotic coronary arteries caused by the cold pressor test. Circulation 77: 43-52. [CrossRef] [Google Scholar] [PubMed]
  26. Flammer AJ, Anderson T, Celermajer DS, Creager MA, Deanfield J, et al. (2012) The assessment of endothelial function: from research into clinical practice. Circulation 1260: 753-767. [CrossRef] [Google Scholar] [PubMed]
  27. Kothawade K, BaireyMerz CN (2011) Microvascular coronary dysfunction in women: pathophysiology, diagnosis, and management. Curr Probl Cardiol 36: 291-318. [CrossRef] [Google Scholar] [PubMed]
  28. Siasos G, Sara JD, Zaromytidou M, Park KH, Coskun AU, et al. (2018) Local Low Shear Stress and Endothelial Dysfunction in Patients With Nonobstructive Coronary Atherosclerosis. J Am Coll Cardiol 71: 2092-2102. [CrossRef] [Google Scholar] [PubMed]
  29. Stone PH, Coskun AU, Kinlay S, Clark ME, Sonka M, et al. (2003) Effect of endothelial shear stress on the progression of coronary artery disease, vascular remodeling, and in-stent restenosis in humans: in vivo 6-month follow-up study. Circulation 108: 438-444. [CrossRef] [Google Scholar] [PubMed]
  30. Beltrame JF, Crea F, Camici P (2009) Advances in coronary microvascular dysfunction. Heart Lung Circ 18: 19-27. [CrossRef] [Google Scholar] [PubMed]
  31. Radico F, Cicchitti V, Zimarino M, Caterina RD (2014) Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests. JACC Cardiovasc Interv 7: 453-463. [CrossRef] [Google Scholar] [PubMed]
  32. Taqueti VR, Di Carli MF (2018) Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options. J Am Coll Cardiol 72: 2625-2641. [CrossRef] [Google Scholar] [PubMed]
  33. Epstein SE, Cannon RO, Bonow RO (1991) Exercise testing in patients with microvascular angina. Circulation 83: III73-III76. [Google Scholar] [PubMed]
  34. Suessenbacher A, Wanitschek M, Dörler J, Neururer S, Frick M, et al. (2014) Sex differences in independent factors associated with coronary artery disease. Wien Klin Wochenschr 126: 718-726. [CrossRef] [Google Scholar] [PubMed]
  35. Huxley RR, Woodward M (2011) Cigarette smoking as a risk factor for coronary heart disease in women compared with men: a systematic review and meta-analysis of prospective cohort studies. Lancet 378: 1297-1305. [CrossRef] [Google Scholar] [PubMed]
  36. Dean J, Cruz S, Mehta P, Merz CNB (2015) Coronary microvascular dysfunction: sex-specific risk, diagnosis, and therapy. Nat Rev Cardiol 12: 406-414. [CrossRef] [Google Scholar] [PubMed]
  37. Sucato V, Evola S, Novo G, Novo S (2013) Diagnosis of coronary microvascular dysfunction in diabetic patients with cardiac syndrome X: comparison by current methods. Recenti Prog Med 104: 63-68. [CrossRef] [Google Scholar] [PubMed]
  38. Carli MFD, Janisse J, Grunberger G, Ager J (2003) Role of chronic hyperglycemia in the pathogenesis of coronary microvascular dysfunction in diabetes. J Am Coll Cardiol 41: 2387-2393. [CrossRef] [Google Scholar] [PubMed]
  39. Liao KP, Huang J, He Z, Cremone G, Lam E, et al. (2019) Coronary microvascular dysfunction in rheumatoid arthritis compared to diabetes mellitus and association with all‐cause mortality. Arthritis Care Res. [CrossRef] [Google Scholar] [PubMed]
  40. Ormseth MJ, Oeser AM, Cunningham A, Bian A, Shintani A, et al. (2014) Reversing vascular dysfunction in rheumatoid arthritis: improved augmentation index but not endothelial peroxisome proliferator-activated receptor gamma agonist therapy. Arthritis rheumatology 66: 2331-2338. [CrossRef] [Google Scholar] [PubMed]
  41. Turiel M, Tomasoni L, Sitia S, Cicala S, Gianturco L, et al. (2010) Effects of long-term disease-modifying antirheumatic drugs on endothelial function in patients with early rheumatoid arthritis. Cardiovasc Ther 28: 53-64. [CrossRef] [Google Scholar] [PubMed]
  42. Ishimori ML, Martin R, Berman DS, Goykhman P, Shaw LJ, et al. (2011) Myocardial ischemia in the absence of obstructive coronary artery disease in systemic lupus erythematosus. JACC Cardiovasc Imaging 4: 27-33. [CrossRef] [Google Scholar] [PubMed]
  43. Shaw LJ, Bairey Merz CN, Pepine CJ, Reis SE, Bittner V, et al. (2006) Insights from the NHLBI-Sponspored Women’s Ischemia Syndrome Evaluation (WISE) Study: Part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 47: S4-S20. [CrossRef] [Google Scholar] [PubMed]
  44. Wessel TR, Arant CB, McGorray SP, Sharaf BL, Reis SE, et al. (2007) Coronary microvascular reactivity is only partially predicted by atherosclerosis risk factors or coronary artery disease in women evaluated for suspected ischemia: results from the NHLBI Women's Ischemia Syndrome Evaluation (WISE). Clin Cardiol 30: 69-74. [CrossRef] [Google Scholar] [PubMed]
  45. Kaski JC (2006) Cardiac syndrome X in women: the role of oestrogen deficiency. Heart 92: iii5-iii9. [CrossRef] [Google Scholar] [PubMed]
  46. Moreau P, d'Uscio L, Lüscher TF (1998) Structure and reactivity of small arteries in aging. Cardiovasc Res 37: 247-253. [CrossRef] [Google Scholar] [PubMed]
  47. Gulati M, Cooper-DeHoff RM, McClure C, Johnson BD, Shaw LJ, et al. (2009) Adverse cardiovascular outcomes in women with nonobstructive coronary artery disease: a report from the Women’s Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project. Arch Intern Med 169: 843-850. [CrossRef] [Google Scholar] [PubMed]
  48. Collins P, Maas A, Prasad M, Schierbeck L, Lerman A, et al. (2020) Endothelial vascular function as a surrogate of vascular risk and aging in women. Mayo Clin Prod 95: 541-553. [CrossRef] [Google Scholar] [PubMed]
  49. Bechlioulis A, Kalantaridou SN, Naka KK, Chatzikyriakidou A, Calis KA, et al. (2010) Endothelial function, but not carotid intima-media thickness, is affected early in menopause and is associated with severity of hot flushes. J Clin Endocrinol Metab 95: 1199-1206 [CrossRef] [Google Scholar] [PubMed]
  50. Chambers JC, Fusi L, Malik IS, Haskard DO, De SM, et al. (2001) Association of maternal endothelial dysfunction with preeclampsia. JAMA 285: 1607-1612. [CrossRef] [Google Scholar] [PubMed]
  51. Hayman R, Warren A, Brockelsby J, Johnson I, Baker P, et al. (2000) Plasma from women with pre-eclampsia induces an in vitro alteration in the endothelium-dependent behaviour of myometrial resistance arteries. BJOG 107: 108-115. [CrossRef] [Google Scholar] [PubMed]
  52. Lau SY, Guild SJ, Barrett CJ, Chen Q, McCowan L, et al. (2013) Tumor necrosis factor-alpha, interleukin-6, and interleukin-10 levels are altered in preeclampsia: a systematic review and meta-analysis. Am J ReprodImmunol 70: 412-427. [CrossRef] [Google Scholar] [PubMed]
  53. Boeldt DS, Bird IM (2017) Vascular adaptation in pregnancy and endothelial dysfunction in preeclampsia. J Endocrinol 232: R27-R44. [CrossRef] [Google Scholar] [PubMed]
  54. Visser S, Hermes W, Ket JC (2014) Systematic review and metanalysis on non-classic cardiovascular biomarkers after hypertensive pregnancy disorders. Am J Obstet Gynecol 211: 373-379. [CrossRef] [Google Scholar] [PubMed]
  55. Bellamy L, Casas JP, Hingorani AD, Williams D (2009) Type 2 diabetes mellitus after gestational diabetes: a systematic review and meta-analysis. Lancet 373: 1773-1779. [CrossRef] [Google Scholar] [PubMed]
  56. Mathews L, Iantorno M, Schar M, Bonanno G, Gerstenblith G, et al. (2017) Coronary endothelial function is better in healthy premenopausal women than in healthy older postmenopausal women and men. PLoS ONE 12: e0186448. [CrossRef] [Google Scholar] [PubMed]
  57. Atsma F, Bartelink ML, Grobbee DE, van der Schouw YT (2006) Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause 13: 265-279 [CrossRef] [Google Scholar] [PubMed]
  58. Kok HS, van Asselt KM, van der Schouw YT (2006) Heart disease risk determines menopausal age rather than the reverse. J Am CollCardiol 47: 1976-1983. [CrossRef] [Google Scholar] [PubMed]
  59. Matthews KA, Crawford SL, Chae CU (2009) Are changes in cardiovascular disease risk factors in midlife women due to chronological aging or to the menopausal transition? J Am CollCardiol 54: 2366-2373. [CrossRef] [Google Scholar] [PubMed]
  60. Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, et al. (2011) Effectiveness-based guidelines for the prevention of cardiovascular disease in women-2011 update: a guideline from the American Heart Association. Circulation 123: 1243-1262. [CrossRef] [Google Scholar] [PubMed]