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Clin Sci (Lond). 2018 Sep 5;132(17):1937-1952. doi: 10.1042/CS20180067. Print 2018 Sep 14.

Coronary artery disease in post-menopausal women: are there appropriate means of assessment?

Author information

1
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
2
Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, U.S.A.
3
Department of Medicine, Cardiac Unit and Centre for Gender Medicine, Karolinska Institutet, Stockholm, Sweden.
4
Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, University of Calgary Cumming School of Medicine, Calgary, AB, Canada ermobrie@ucalgary.ca.

Abstract

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.

KEYWORDS:

atherosclerosis; biomarkers; coronary artery disease; imaging; menopause; women

PMID:
30185615
DOI:
10.1042/CS20180067

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