Women and Coronary Artery Disease (CAD).ppt

Women and Coronary Artery Disease (CAD)
Module 2 Risk Factors and Gender Differences
Supported by an unrestricted educational grant from Fujisawa Healthcare, Inc.
Gender Differences in Atherosclerosis
Women undergoing coronary angiography have more diffuse atherosclerosis measured by IVUS, more promised lumen adjusted for BSA throughout the arterial pared to men (WISE study)
Women and men have similar magnitude of atherosclerosis, but it looks and functions differently, possibly for estrogen-related reasons.
A consequence of more diffuse atherosclerosis might be more microvascular disease (limited flow reserve) that is not due to obvious obstructive disease*
*C. Noel Bairey-Merz. WISE study data ACC 3/2002
Gender Differences in Atherosclerosis
1996 Farb et al: two distinct plaque morphologies in sudden coronary death (SCD)
Plaque rupture: thin fibrous cap over a large necrotic core heavily infiltrated by foamy macrophages: 60% of thrombi in SCD
Plaque Erosion: thrombus over a base rich in smooth muscle with a proteoglycan-rich matrix (necrotic core is often absent): 40% of thrombi in SCD
Farb A, et al. Circulation. 1996
Gender Differences in Atherosclerosis
1999 Arbustini et al: Plaque erosion: major substrate for coronary thrombosis in acute myocardial infarction (MI); 291/298 patients (98% with MI) had coronary thrombi at autopsy
Of the 25% of this autopsy cohort with plaque erosion: women = 37% and men = 18%
Arbustini E, et al. Heart. 1999
Gender Differences in Atherosclerosis
1998 Burke et al: effect of risk factors on the mechanism of acute thrombosis and SCD in women (N = 51 women died from SCD)
Plaque erosion was highly correlated with cigarette smoking and was the most frequent type of coronary thrombosis seen in women <50 years
Plaque rupture: most frequent mode of coronary thrombosis in women >50 years and correlated with elevated serum total cholesterol
Burke AP, et al. Circulation. 1998
Gender Differences in Atherosclerosis
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