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Thursday, 6 September 2012

Ischemic Heart Disease and Women
One of the many amazing (and distinguished) cardiologist I am fortunate to know is Dr. Noel Bairey Merz. Read more about her here. She and her colleagues in their 2009 article (see here) posit that the female presentation of disease may be due, in part to ischemia presenting differently in women (as compared to men)
In a rudimentary perspective, ischemia is often viewed as obstruction (due to atheromatous plaques and sticky platelets.)

 As the diameter of the vessel becomes more compromised and when demand for blood flow goes up (e.g. exercise), the mismatch of needed blood to tissues and that delivered results in pressure, pain or symptoms.
The clogged vessel approach may be true for some people (men and women) but it does not explain why women (with cardiovascular risks and normal catheterizations) respond better to treatment similar to those with obstructive disease.
The endothelial response of illness in ischemia, may be in part a reason why women, vs men experience a)no symptoms (yet have disease); b) 'different' symptoms - fast heart rate, GI upset, profound fatigue and c) die at higher numbers than their male counterparts.

So here again, we have the opportunity that sex and gender medicine can present inroads to the pathophysiology of ischemic heart disease that is accurate for both women and men - but we are still early in the game. Read more in the article link above and search the blog for other useful resources and stats.

For the latest guidelines check out Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women—2011 Update overseen by Lori Mosca, MD, MPH, PhD and Professor of Medicine and Preventive Cardiology at Columbia.

Two of our Drexel Heart Health Medicine experts contributed to this - Dr Katherine Sherif Associate Professor of Medicine and Director of the Center for Women's Health and Dr Ellie Kelepouris, Professor of Medicine, Section Chief of Nephrology and Vice Chair for Medical Education

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