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Angina common among women, not associated with atherosclerosis
Banks K. J Am Coll Cardiol Img. 20114:65-73.
Bairey Merz CN. J Am Coll Cardiol Img. 20114:74-77.
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Data from a new study suggest that angina detected by CT is common among women, but is not associated with subclinical atherosclerosis.
“Angina in women is a morbid condition for which the determinants are poorly characterized,” Kamakki Banks, MD, and fellow investigators wrote. “More than 50% of women with angina may have normal or near-normal coronary arteries visualized at coronary angiography, a rate much higher than is observed among men. Coronary angiography, however, is an insensitive measure of atherosclerosis burden, and some have hypothesized that subclinical atherosclerosis may promote microvascular dysfunction and ischemia in women with angina in the absence of obstructive epicardial coronary disease.”
This hypothesis led the researchers to evaluate the relationship between angina and coronary artery calcium (CAC) in women via data compiled from the multi-ethnic Dallas Heart Study. The final study population included 1,480 women (49% African American) with a mean age of 45 years.
Overall, 6.9% of the population had angina, which was not associated with CAC (P=.20). For women without CAC, variables that included obesity and insulin resistance were associated with angina, whereas independent factors for angina included African-American ethnicity, waist circumference and premature family history of MI (P<.05 for all). Women with angina vs. without had higher levels of reduced aortic compliance (P=.007), soluble vascular cell adhesion molecule-1 (P=.01) and soluble intercellular adhesion molecule-1 (P=.02).
“Typical exertional angina affects one of every 14 women between the ages of 30 and 65 years in Dallas County. Interestingly, angina was not associated with subclinical atherosclerosis among women,” the investigators wrote. “Angina that occurs in the absence of subclinical atherosclerosis was not related to many traditional atherosclerotic risk factors; however, it was associated with measures of vascular stiffness and endothelial dysfunction, suggesting a distinct vascular etiology and alternate potential therapeutic targets for this entity compared with atherosclerosis.”
C. Noel Bairey Merz, MD,with the Women’s Heart Center, Cedars-Sinai Medical Center, Los Angeles, wrote in an accompanying editorial that current alternative strategies utilizing tools to detect vulnerable patients should be useful in diagnosis and may even be preferential in women.
“Novel imaging strategies aimed at pathophysiological pathways, including measures of nonendothelial, endothelial function, vascular and myocardial compliance, as well as myocardial perfusion and flow reserve are actively being investigated as useful risk markers and diagnostic strategies,” she said. “Noninvasive, nonionizing radiation strategies are needed for this purpose, as invasive study has documented the feasibility of identifying future risk by pathophysiological evaluation in women with no obstructive CAD.”
Disclosure: Dr. Bairey Merz has received grants, contract support and lecture honoraria and has acted as a consultant for many companies and institutions. She also reported owning stock in Medtronic and Johnson and Johnson.
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