关注女性缺血性心脏病冠状动脉微血管病变

Coronary microvascular dysfunction in women with ischemicaheart disease

缺血性心脏病(IHD)已成为最重要的心血管疾病之一。其发生、发展、治疗和预后存在性别差异。与男性相比,女性非阻塞性冠心病、冠状动脉微血管功能障碍(CMD)和射血分数保留性心力衰竭(HFpEF)的患病率更高,其机制可能与性激素对自主神经、内皮/血管张力、肾素-血管紧张素-醛固酮系统(RAAS)等的调节有关。目前尚缺乏针对女性CMD的前瞻性随机临床试验证据和诊治指南。本文就女性IHD的特点,以及CMD的流行病学、危险因素、临床评估和治疗的性别差异进行综述。

Ischemic heart disease(IHD) has become one of the most important cardiovascular diseases.There are gender differences in its pathogenesis,development,treatment and prognosis.Compared with men,women have higher prevalence of non-obstructive coronary heart disease,coronary microvascular dysfunction(CMD) and heart failure with preserved ejection fraction(HFpEF),which may be related to the regulation of sex hormones on autonomic nervous system,endothelial/vascular tension,renin angiotensin aldosterone system system(RAAS),etc.At present,there is few evidence from prospective randomized clinical trials and guidelines for diagnosis and treatment of female CMD.This article reviews the characteristics of female IHD and the gender differences in the epidemiology,risk factors,clinical evaluation and treatment of CMD.