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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 2009; 169(9):843-50AI

Abstract

BACKGROUND

Women with clinical findings suggestive of ischemia but without findings of obstructive coronary artery disease (CAD) on angiography represent a frequent clinical problem; predicting prognosis is challenging.

METHODS

The Women's Ischemia Syndrome Evaluation (WISE) study examined symptomatic women referred for clinically indicated coronary angiography and followed up for a mean 5.2 years. The St James Women Take Heart (WTH) Project enrolled asymptomatic, community-based women with no history of heart disease who were followed up for 10 years. We compared cardiovascular events (ie, myocardial infarction, stroke, and hospitalization for heart failure) and death in 540 WISE women with suspected ischemia but no angiographic evidence of obstructive CAD with those from a cohort of 1000 age- and race-matched WTH women.

RESULTS

Compared with the WISE women, asymptomatic WTH women had a lower prevalence of obesity, family history of CAD, hypertension, and diabetes mellitus (P < .001). Five-year annualized event rates for cardiovascular events were 16.0% in WISE women with nonobstructive CAD (stenosis in any coronary artery of 1%-49%), 7.9% in WISE women with normal coronary arteries (stenosis of 0% in all coronary arteries), and 2.4% in asymptomatic WTH women (P < or = .002), after adjusting for baseline CAD risk factors. The cardiovascular events were most frequent in women with 4 or more cardiac risk factors, with the 5-year annualized cardiovascular event rate being 25.3% in women with nonobstructive CAD, 13.9% in WISE women with normal coronary arteries, and 6.5% in asymptomatic women (P = .003).

CONCLUSION

Women with symptoms and signs suggestive of ischemia but without obstructive CAD are at elevated risk for cardiovascular events compared with asymptomatic community-based women.

Authors+Show Affiliations

Department of Medicine and Preventive Medicine, Northwestern University, 201 E Huron, Chicago, IL 60611, USA. m-gulati@northwestern.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19433695

Citation

Gulati, Martha, et al. "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." Archives of Internal Medicine, vol. 169, no. 9, 2009, pp. 843-50.
Gulati M, Cooper-DeHoff RM, McClure C, et al. 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. 2009;169(9):843-50.
Gulati, M., Cooper-DeHoff, R. M., McClure, C., Johnson, B. D., Shaw, L. J., Handberg, E. M., ... Merz, C. N. (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. Archives of Internal Medicine, 169(9), pp. 843-50. doi:10.1001/archinternmed.2009.50.
Gulati M, et al. 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. 2009 May 11;169(9):843-50. PubMed PMID: 19433695.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - 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. AU - Gulati,Martha, AU - Cooper-DeHoff,Rhonda M, AU - McClure,Candace, AU - Johnson,B Delia, AU - Shaw,Leslee J, AU - Handberg,Eileen M, AU - Zineh,Issam, AU - Kelsey,Sheryl F, AU - Arnsdorf,Morton F, AU - Black,Henry R, AU - Pepine,Carl J, AU - Merz,C Noel Bairey, PY - 2009/5/13/entrez PY - 2009/5/13/pubmed PY - 2009/6/9/medline SP - 843 EP - 50 JF - Archives of internal medicine JO - Arch. Intern. Med. VL - 169 IS - 9 N2 - BACKGROUND: Women with clinical findings suggestive of ischemia but without findings of obstructive coronary artery disease (CAD) on angiography represent a frequent clinical problem; predicting prognosis is challenging. METHODS: The Women's Ischemia Syndrome Evaluation (WISE) study examined symptomatic women referred for clinically indicated coronary angiography and followed up for a mean 5.2 years. The St James Women Take Heart (WTH) Project enrolled asymptomatic, community-based women with no history of heart disease who were followed up for 10 years. We compared cardiovascular events (ie, myocardial infarction, stroke, and hospitalization for heart failure) and death in 540 WISE women with suspected ischemia but no angiographic evidence of obstructive CAD with those from a cohort of 1000 age- and race-matched WTH women. RESULTS: Compared with the WISE women, asymptomatic WTH women had a lower prevalence of obesity, family history of CAD, hypertension, and diabetes mellitus (P < .001). Five-year annualized event rates for cardiovascular events were 16.0% in WISE women with nonobstructive CAD (stenosis in any coronary artery of 1%-49%), 7.9% in WISE women with normal coronary arteries (stenosis of 0% in all coronary arteries), and 2.4% in asymptomatic WTH women (P < or = .002), after adjusting for baseline CAD risk factors. The cardiovascular events were most frequent in women with 4 or more cardiac risk factors, with the 5-year annualized cardiovascular event rate being 25.3% in women with nonobstructive CAD, 13.9% in WISE women with normal coronary arteries, and 6.5% in asymptomatic women (P = .003). CONCLUSION: Women with symptoms and signs suggestive of ischemia but without obstructive CAD are at elevated risk for cardiovascular events compared with asymptomatic community-based women. SN - 1538-3679 UR - https://www.unboundmedicine.com/medline/citation/19433695/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_ L2 - https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/10.1001/archinternmed.2009.50 DB - PRIME DP - Unbound Medicine ER -