Among women presenting for evaluation of suspected ischemic symptoms a Rabbit Polyclonal to MAD2L1. diagnosis of normal coronary arteries is five occasions more common as compared to men. the current platform of therapy consists of anti-anginal anti-platelet and endothelial modifying agents (primarily angiotensin transforming enzyme inhibitors and statins). Introduction Among women presenting for evaluation of suspected ischemic symptoms a diagnosis of normal coronary arteries is usually five times more common as compared to men.1 Other studies demonstrate that women are less likely than age-matched men to have obstructive coronary artery disease Docetaxel (Taxotere) (CAD).2 These women are often labeled as cardiac syndrome X (CSX) defined as the triad of chest pain abnormal stress testing consistent with ischemia and absence of obstructive CAD (i.e. ≥50% stenosis in ≥ 1 coronary artery) on coronary angiography.3 CSX is classically acknowledged as a female predominant disorder and nearly 70% of patients diagnosed as having CSX are women.4 Among subjects suspected to have myocardial ischemia and referred for clinically indicated coronary angiography 41 of women versus only 8% of the men studied showed non-significant epicardial CAD.1 The large Coronary Artery Surgery Study (CASS) of nearly 25 0 subjects evaluated after undergoing angiography further points towards the female predominance of having chest pain with normal coronary arteries.5 More recently similar results have been described with coronary computed tomographic angiography (CCTA).6 Symptom-driven care for women in the absence of obstructive CAD is substantial.7 For ladies with signs and symptoms of ischemia but no obstructive CAD the average lifetime cost for ischemic heart disease (IHD) is $ 767 288 comparable to the magnitude of more than $1 million dollars for ladies with obstructive CAD. Based on these data we have estimated the societal economic burden for CAD care for women with angina could exceed $162 billion dollars annually in the US with approximately half of this expenditure on women with no obstructive CAD.7 While some studies on ongoing in this area there is a clear need for future research on microvascular angina and some suggestions for future research suggestions are presented in Table 1. Table 1 Five Top Research Questions for Microvascular Coronary Dysfunction Pathogenesis A Docetaxel (Taxotere) subset of patients with CSX have microvascular angina (MA)8ENREF 8 due to microvascular coronary dysfunction (MCD). The conditions of CSX and its subentity MA due to MCD are progressively investigated yet full elucidation of their pathogenesis remains lacking. Despite the considerable effort of research over the last 4 decades9 there is no universally accepted understanding of the pathogenesis of signs and symptoms of ischemia and no obstructive CAD.9 10 Suggested mechanisms9-11 of CSX include altered regulation of coronary microcirculation through autonomic dysregulatory and endothelial mechanisms generalized vascular disorder and abnormal subendocardial perfusion. Other suggested contributing factors include inflammation hyperinsulinemia enhanced sodium-hydrogen exchange hormonal deficiency abnormal pain belief Docetaxel (Taxotere) and lastly inherent pathogenetic pathways. MA due to MCD appears to be a major etiologic mechanism underlying chest pain evoked by ischemia in patients with CSX Docetaxel (Taxotere) (Physique 1). It refers to abnormalities in the vasomotor or metabolic regulators of the smaller resistance coronary arterioles (<500um) although structural abnormalities of Docetaxel (Taxotere) the microcirculation (for example smooth muscle mass cell hypertrophy) have been explained by some12 but not all studies.13 Although small coronary arterioles are not visualized during coronary angiography they are the major determinants of coronary vascular resistance.14 Experimental studies and clinical observations highlight the role of sex differences in microvascular pathophysiology.15 Evidence from autopsy data suggests that women may have a higher frequency of coronary plaque erosion and microembolization16 which could result in greater MCD. Results from retinal photography implicate sex-specific dysfunction of the microvasculature. Retinal arterial narrowing Docetaxel (Taxotere) a measure of microvascular disease is related to cardiovascular disease risk and mortality in women but in men.17 Determine 1 Model of Microvascular Angina in Women. HTN=hypertension PCOS=polycystic ovary syndrome.