Compared to men, women have less chances of developing obstructive coronary artery disease (CAD), but this new study suggests they are more prone to have lower coronary flow reserve, which is also a risk factor.
Evidently, ischemic cardiomyopathy entails far more than assessing and treating plaque burden in epicardial arteries. In women, the most prevalent pathological phenotype was low coronary flow reserve in absence of OBSTRUCTIVE CAD, while in men, most of patients presenting low coronary flow reserve had multiple vessels disease.
This study, simultaneously published in Circulation, assessed 329 patients (43% women) referred for a coronary angiography after positive stress test and > 40% ejection fraction.
Regardless of their similar age, cardiovascular medication and ischemia extension, women had lower pretest clinical risk, with lower rates of MI and burden of angiographic CAD, compared to men.
Moreover, women also presented less obstructive CAD and lower revascularization rate. Despite of traditional scores, women had higher risk of events at 3 years.
After adjusting for epicardial disease, women continued to have higher events risk than men (HR 2.05; 95% CI 1.05-4.02).
No doubt, we need to better understand the relationship between microvascular dysfunction and comorbidities, such as insulin resistance or cardiac failure.
Coronary flow reserve could be an important risk marker, not only for prospective studies assessing the role of ischemia and revascularization, but also as a target for new anti-inflammatory or hypolipidemic drugs, or neurohormone modulators.
Original Title: Excess cardiovascular risk in women relative to men referred for coronary angiography is associated with severely impaired coronary flow reserve, not obstructive disease.
Presenter: Taqueti VR.
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