Prevalence of Coronary Endothelial and Microvascular Dysfunction in Women with Symptoms of Ischemia and No Obstructive Coronary Artery Disease Is Confirmed by a New Cohort: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD).
Cohort Studies
Coronary Angiography
/ methods
Coronary Vessels
/ physiopathology
Endothelium, Vascular
/ physiopathology
Female
Humans
Microvessels
/ physiopathology
Middle Aged
Myocardial Ischemia
/ diagnosis
National Heart, Lung, and Blood Institute (U.S.)
Prognosis
Risk Factors
United States
/ epidemiology
Journal
Journal of interventional cardiology
ISSN: 1540-8183
Titre abrégé: J Interv Cardiol
Pays: United States
ID NLM: 8907826
Informations de publication
Date de publication:
2019
2019
Historique:
received:
26
10
2018
revised:
28
01
2019
accepted:
24
02
2019
entrez:
28
11
2019
pubmed:
28
11
2019
medline:
29
2
2020
Statut:
epublish
Résumé
In a separate, contemporary cohort, we sought to confirm findings of the original Women's Ischemia Syndrome Evaluation (WISE). The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up. We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG). In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively. This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.
Sections du résumé
OBJECTIVE
OBJECTIVE
In a separate, contemporary cohort, we sought to confirm findings of the original Women's Ischemia Syndrome Evaluation (WISE).
BACKGROUND
BACKGROUND
The original WISE observed a high prevalence of both invasively determined coronary endothelial and coronary microvascular dysfunction (CMD) that predicted adverse events in follow-up.
METHODS
METHODS
We comparatively studied the WISE-Coronary Vascular Dysfunction (CVD) cohort (2009-2011), with signs and symptoms of ischemia but without significant CAD, to the original WISE (1997-2001) cohort. CMD was defined as coronary flow reserve (CFR) ≤2.5, or endothelial dysfunction as epicardial coronary artery constriction to acetylcholine (ACH), or <20% epicardial coronary dilation to nitroglycerin (NTG).
RESULTS
RESULTS
In WISE (n=181) and WISE-CVD (n=235) women, mean age in both was 54 years, and 83% were white (WISE) vs 74% (WISE-CVD, p=0.04). Use of hormone replacement therapy was less frequent in WISE-CVD vs WISE (46% vs 57%, p=0.026) as was presence of hypertension (40% vs 52%, p=0.013), hyperlipidemia (20% vs 46%, p<0.0001), and smoking (46% vs 56%, p=0.036). Similar rates were observed in WISE-CVD and WISE cohorts for CMD (mean CFR 2.7±0.6 vs 2.6±0.8, p=0.35), mean change in diameter with intracoronary ACH (0.2±10.0 vs 1.6±12.8 mm, p=0.34), and mean change in diameter with intracoronary NTG (9.7±13.0 vs 9.8±13.5 mm, p=0.94), respectively.
CONCLUSIONS
CONCLUSIONS
This study confirms prevalence of CMD in the contemporary WISE-CVD cohort similar to that of the original WISE cohort, despite a lower risk factor burden in WISE-CVD. Because these coronary functional abnormalities predict major adverse cardiac events, clinical trials of therapies targeting these abnormalities are indicated.
Identifiants
pubmed: 31772544
doi: 10.1155/2019/7169275
pmc: PMC6739787
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
7169275Subventions
Organisme : NHLBI NIH HHS
ID : N01 HV068161
Pays : United States
Organisme : NHLBI NIH HHS
ID : N01HV68162
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000064
Pays : United States
Organisme : NIA NIH HHS
ID : R03 AG032631
Pays : United States
Organisme : NHLBI NIH HHS
ID : T32 HL069751
Pays : United States
Organisme : NHLBI NIH HHS
ID : N01HV68163
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000124
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001427
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL033610
Pays : United States
Organisme : NCRR NIH HHS
ID : M01 RR000425
Pays : United States
Organisme : NHLBI NIH HHS
ID : UM1 HL087366
Pays : United States
Organisme : NHLBI NIH HHS
ID : R37 HL033610
Pays : United States
Organisme : NHLBI NIH HHS
ID : K23 HL105787
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL090957
Pays : United States
Organisme : NHLBI NIH HHS
ID : N01 HV068164
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL056921
Pays : United States
Informations de copyright
Copyright © 2019 R. David Anderson et al.
Déclaration de conflit d'intérêts
There are no relevant conflicts of interest of any of the authors to disclose.
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