Research and Education
Women's Heart Health at Stanford under the umbrella of the Stanford Cardiovascular Institute is actively involved in research investigating women's cardiovascular health and sex differences in cardiovascular disease. Here are some of our current projects and links to recent publications.
Current Projects:
- Sex Differences in the Pathophysiology of Symptomatic Non-Obstructive Coronary Disease
- Sex Differences in Occurrence and Management of Chronically Occluded Coronary Arteries
- Predictors of Elevated Coronary Artery Calcium Scores in Women
- Incidence of Depression and Anxiety in Women Presenting to a Women's Cardiovascular Health Clinic: A Pilot Study
- Microvascular Resistance in Women Presenting with Tako-Tsubo Cardiomyopathy Compared with Acute Myocardial Infarction
- Sex Differences in Outcomes Following First Incidence of Myocardial Infarction or Unstable Angina
- The Obesity Paradox in Women Compared with Men Following Percutaneous Coronary Intervention for Acute Coronary Syndrome
Principal Investigator: Jennifer A. Tremmel, MD, MS
Condition/Disease: Symptoms concerning for angina, but normal appearing coronary arteries on angiography.
Description:
Approximately 20% of patients with symptoms concerning for coronary artery disease (such as chest pain or shortness of breath, also known as angina) are found to have normal appearing coronary arteries on angiography. This is a particularly common scenario for women, who are then told that nothing is wrong with their heart. However, when no other cause is found, they are left with unexplained and untreated symptoms that become a frustration to both themselves and their physician. Recent evidence suggests that women often have pathologic and physiologic abnormalities of their coronary arterial tree that may be the source of their symptoms. These pathophysiologic abnormalities, including endothelial dysfunction, microvascular disease, and diffuse non-obstructive atherosclerotic plaque, cannot be detected by angiography alone. Such information presents an intriguing basis for a sex difference in coronary pathophysiology, however, whether or not these pathophysiologic abnormalities actually occur more frequently in women than in similarly presenting men remains unknown.
The primary question being asked by this study is "are women with symptoms of angina, but normal appearing coronary arteries by angiography, more likely than similarly presenting men to have coronary pathophysiology abnormalities, including endothelial dysfunction, microvascular disease, and diffuse deposition of coronary atherosclerotic plaque?" We will attempt to answer this question by assessing both women and men with angina, but normal appearing coronary arteries for endothelial dysfunction, microvascular disease, and diffuse atherosclerotic plaque, and then evaluating for differences in the frequency and severity of these abnormalities between the sexes. We will also be investigating sex differences in the risk factors associated with these abnormalities and differences in long-term cardiovascular outcomes between the sexes.
Recent Publications:
Postmenopausal Hormone Therapy and Risk of Cardiovascular Disease by Age and Years Since Menopause. JAMA 2007;297:1465-1477. More »
Ischemic heart disease in women: an appropriate time to discriminate. Rev Cardiovasc Med 2007;8(2):61-8.
Estrogen Therapy and Coronary Artery Calcification. N Engl J Med 2007;356:2591-2602. More »
Farouque OHM, Tremmel J, Shabari FR, Aggarwal M, Fearon W, Ng M, Rezaee M, Yeung A, Lee DP. Women remain at higher risk for retroperitoneal hematoma after percutaneous coronary intervention in the era of glycoprotein IIb/IIIa inhibitors and vascular closure devices. J Am Coll Cardiol. 2005;45:363-8.