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Article ; Online: A case of ultra-prolonged intra-aortic balloon pump support via sheathless femoral access.

Al-Ani, Mohammad A / Snipes, Garrett / Parker, Alex M / Kerensky, Richard A

European heart journal. Case reports

2023 Volume 7, Issue 8, Page(s) ytad394

Abstract: Background: An intra-aortic balloon pump (IABP) is a mechanical circulatory support platform with a relatively low complication rate. Axillary access is increasingly utilized to allow rehabilitation.: Case summary: We present a case of femoral IABP ... ...

Abstract	Background: An intra-aortic balloon pump (IABP) is a mechanical circulatory support platform with a relatively low complication rate. Axillary access is increasingly utilized to allow rehabilitation. Case summary: We present a case of femoral IABP inserted into the femoral artery percutaneously via a sheathless technique that allowed the patient to ambulate and physically rehabilitate over 102 days until cardiac transplantation. The patient was able to progress with the protocolized rehabilitation programme to up to 3500 ft walking distance. The IABP was removed at the time of transplantation without any vascular complications. Discussion: While axillary IABP offers an opportunity to rehabilitate, it has an unacceptably high complication rate, often resulting in vascular injury that adds morbidity to an acutely ill cohort. In this case, we found that sheathless femoral IABP access offered stability for a prolonged time while avoiding pain, bleeding, infection, and vascular injury. We hypothesize that this is due to less indwelling prosthetic material usage and also device flexibility, allowing conformation to the natural course of the femoral artery. We are encouraged by this case to use a sheathless access approach for patients expected to require prolonged IABP support.
Language	English
Publishing date	2023-08-17
Publishing country	England
Document type	Case Reports
ISSN	2514-2119
ISSN (online)	2514-2119
DOI	10.1093/ehjcr/ytad394
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Article ; Online: Effectiveness of Clopidogrel vs Alternative P2Y

Journal of the American College of Cardiology

2024 Volume 83, Issue 15, Page(s) 1370–1381

Abstract: Background: An ABCD-GENE (age, body mass index, chronic kidney disease, diabetes, and CYP2C19 genetic variants) score ≥10 predicts reduced clopidogrel effectiveness, but its association with response to alternative therapy remains unclear.: Objectives! ...

Abstract	Background: An ABCD-GENE (age, body mass index, chronic kidney disease, diabetes, and CYP2C19 genetic variants) score ≥10 predicts reduced clopidogrel effectiveness, but its association with response to alternative therapy remains unclear. Objectives: The aim of this study was to evaluate the association between ABCD-GENE score and the effectiveness of clopidogrel vs alternative P2Y Methods: A total of 4,335 patients who underwent PCI, CYP2C19 genotyping, and P2Y Results: Among patients with scores <10 (n = 3,200), MAE was not different with alternative therapy vs clopidogrel (weighted HR: 0.89; 95% CI: 0.65-1.22; P = 0.475). The risk for MAE also did not significantly differ by treatment among patients with scores ≥10 (n = 1,135; weighted HR: 0.75; 95% CI: 0.51-1.11; P = 0.155). Among CYP2C19 LOF allele carriers, MAE risk appeared lower with alternative therapy in both the group with scores <10 (weighted HR: 0.50; 95% CI: 0.25-1.01; P = 0.052) and the group with scores ≥10 (weighted HR: 0.48; 95% CI: 0.29-0.80; P = 0.004), while there was no difference in the group with scores <10 and no LOF alleles (weighted HR: 1.03; 95% CI: 0.70-1.51; P = 0.885). Conclusions: These data support the use of alternative therapy over clopidogrel in CYP2C19 LOF allele carriers after PCI, regardless of ABCD-GENE score, while clopidogrel is as effective as alternative therapy in non-LOF patients with scores <10.
MeSH term(s)	Humans ; Clopidogrel ; Platelet Aggregation Inhibitors ; Cytochrome P-450 CYP2C19/genetics ; Percutaneous Coronary Intervention/adverse effects ; Ticagrelor/therapeutic use ; Treatment Outcome ; Genotype
Chemical Substances	Clopidogrel (A74586SNO7) ; Platelet Aggregation Inhibitors ; Cytochrome P-450 CYP2C19 (EC 1.14.14.1) ; Ticagrelor (GLH0314RVC)
Language	English
Publishing date	2024-04-08
Publishing country	United States
Document type	Journal Article
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2024.02.015
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Article: Massive Tension Hemothorax After Pacemaker Implantation.

Matthia, Eldon / Matar, Ralph / Altshuler, Ellery / Kerensky, Richard A / Arnaoutakis, George / Shah, Samir / Omar, Abdullah / Agarwal, Zubin / Miles, William / Xiang, Kun

Cureus

2021 Volume 13, Issue 7, Page(s) e16754

Abstract: A case of an 85-year-old male on apixaban and clopidogrel undergoing pacemaker implantation is described. After procedure he developed unilateral tension hemothorax and required emergent drainage and exploratory thoracotomy. No vascular, cardiac, or ... ...

Abstract	A case of an 85-year-old male on apixaban and clopidogrel undergoing pacemaker implantation is described. After procedure he developed unilateral tension hemothorax and required emergent drainage and exploratory thoracotomy. No vascular, cardiac, or pulmonary source was identified. After multidisciplinary discussions, it was speculated that spontaneous intercostal vessel rupture due to forceful coughing and elevated blood pressure during the procedure was the most likely cause of bleeding.
Language	English
Publishing date	2021-07-30
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.16754
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Article ; Online: Impact of the ABCD-GENE Score on Clopidogrel Clinical Effectiveness after PCI: A Multi-Site, Real-World Investigation.

Clinical pharmacology and therapeutics

2022 Volume 112, Issue 1, Page(s) 146–155

Abstract: The Age, Body mass index, Chronic kidney disease, Diabetes mellitus, and CYP2C19 GENEtic variants (ABCD-GENE) score was developed to identify patients at risk for diminished antiplatelet effects with clopidogrel after percutaneous coronary intervention ( ... ...

Abstract	The Age, Body mass index, Chronic kidney disease, Diabetes mellitus, and CYP2C19 GENEtic variants (ABCD-GENE) score was developed to identify patients at risk for diminished antiplatelet effects with clopidogrel after percutaneous coronary intervention (PCI). The objective of this study was to validate the ability of the ABCD-GENE score to predict the risk for atherothrombotic events in a diverse, real-world population of clopidogrel-treated patients who underwent PCI and received clinical CYP2C19 genotyping to guide antiplatelet therapy. A total of 2,341 adult patients who underwent PCI, were genotyped for CYP2C19, and received treatment with clopidogrel across four institutions were included (mean age 64 ± 12 years, 35% women, and 20% Black). The primary outcome was major atherothrombotic events, defined as the composite of all-cause death, myocardial infarction, ischemic stroke, stent thrombosis, or revascularization for unstable angina within 12 months following PCI. Major adverse cardiovascular events (MACE), defined as the composite of cardiovascular death, myocardial infarction, ischemic stroke, or stent thrombosis, was assessed as the secondary outcome. Outcomes were compared between patients with an ABCD-GENE score ≥ 10 vs. < 10. The risk of major atherothrombotic events was higher in patients with an ABCD-GENE score ≥ 10 (n = 505) vs. < 10 (n = 1,836; 24.6 vs. 14.7 events per 100 patient-years, adjusted hazard ratio (HR) 1.66, 95% confidence interval (CI), 1.23-2.25, P < 0.001). The risk for MACE was also higher among patients with a score ≥ 10 vs. < 10 (16.7 vs. 10.1 events per 100 patient-years, adjusted HR 1.59, 95% CI 1.11-2.30, P = 0.013). Our diverse, real-world data demonstrate diminished clopidogrel effectiveness in post-PCI patients with an ABCD-GENE score ≥ 10.
MeSH term(s)	Aged ; Clopidogrel/therapeutic use ; Cytochrome P-450 CYP2C19/genetics ; Female ; Humans ; Ischemic Stroke/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Percutaneous Coronary Intervention ; Platelet Aggregation Inhibitors/therapeutic use ; Treatment Outcome
Chemical Substances	Platelet Aggregation Inhibitors ; Clopidogrel (A74586SNO7) ; CYP2C19 protein, human (EC 1.14.14.1) ; Cytochrome P-450 CYP2C19 (EC 1.14.14.1)
Language	English
Publishing date	2022-05-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	123793-7
ISSN	1532-6535 ; 0009-9236
ISSN (online)	1532-6535
ISSN	0009-9236
DOI	10.1002/cpt.2612
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Article: Angiographic patterns and the natural history of the vulnerable plaque.

Monroe, V Stephen / Parilak, Leonard D / Kerensky, Richard A

Progress in cardiovascular diseases

2002 Volume 44, Issue 5, Page(s) 339–347

Abstract: Coronary angiography is the gold standard for the identification of obstructive coronary artery disease (CAD). The use of this diagnostic test in the evaluation of many clinical syndromes of CAD has yielded a wealth of angiographic data relative to the ... ...

Abstract	Coronary angiography is the gold standard for the identification of obstructive coronary artery disease (CAD). The use of this diagnostic test in the evaluation of many clinical syndromes of CAD has yielded a wealth of angiographic data relative to the vulnerable atherosclerotic plaque. This chapter reviews these important data including the limitations of the angiogram in vulnerable plaque detection, angiographic patterns of complex plaques or "culprit lesions," and the natural history of the complex angiographic lesion.
MeSH term(s)	Coronary Angiography ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/pathology ; Coronary Thrombosis/diagnostic imaging ; Coronary Thrombosis/pathology ; Humans
Language	English
Publishing date	2002-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	209312-1
ISSN	1532-8643 ; 1873-1740 ; 0033-0620
ISSN (online)	1532-8643 ; 1873-1740
ISSN	0033-0620
DOI	10.1053/pcad.2002.123476
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Article: Pharmacologic plaque passivation for the reduction of recurrent cardiac events in acute coronary syndromes.

Monroe, V Stephen / Kerensky, Richard A / Rivera, Enrique / Smith, Karen M / Pepine, Carl J

Journal of the American College of Cardiology

2003 Volume 41, Issue 4 Suppl S, Page(s) 23S–30S

Abstract: Acute coronary syndrome (ACS) is often associated with the rupture of vulnerable atherosclerotic plaque, coronary thrombus formation, and abrupt limitation of blood flow, leading to adverse outcomes. Passivation of vulnerable plaque represents a ... ...

Abstract	Acute coronary syndrome (ACS) is often associated with the rupture of vulnerable atherosclerotic plaque, coronary thrombus formation, and abrupt limitation of blood flow, leading to adverse outcomes. Passivation of vulnerable plaque represents a therapeutic concept that has the potential to prevent or limit the magnitude of a new rupture in order to reduce the recurrence or severity of events. Plaque passivation can be defined as a process by which the structure or content of the atherosclerotic plaque is changed to reduce the risk of subsequent rupture and thrombosis. This may be achieved by using strategies that address different components of the plaque or the endothelium. The following factors can affect the susceptibility of plaque to rupture: macrophage infiltration; accumulation of inflammatory cells; paracrine secretion of enzymes that may cause degradation of the fibrous cap of coronary plaque; shear stress; circadian rhythm variation in stress hormone release; and infectious agents. The use of pharmacologic agents to reduce plaque vulnerability by passivation has been explored. Clinical studies demonstrate that lipid-modifying agents (e.g., statins), antiplatelet agents (acetylsalicylic acid, thienopyridines, thianopyridines, glycoprotein IIb/IIIa inhibitors), and antithrombotic agents (unfractionated heparin and low-molecular-weight heparin) can reduce the occurrence of acute coronary events in ACS patients. In addition, angiographic studies suggest that statins may also promote regression of atherosclerosis. Angiotensin-converting enzyme inhibitors, niacin, and calcium antagonists may also contribute to plaque passivation. This article reviews atherosclerotic plaque development and vulnerability and discusses some clinical studies highlighting the role of plaque passivation in the management of ACS patients.
MeSH term(s)	Abciximab ; Acute Disease ; Angina, Unstable/etiology ; Angina, Unstable/prevention & control ; Antibodies, Monoclonal/therapeutic use ; C-Reactive Protein/analysis ; Coronary Artery Disease/complications ; Coronary Artery Disease/drug therapy ; Coronary Artery Disease/physiopathology ; Coronary Thrombosis/complications ; Coronary Thrombosis/physiopathology ; Disease Progression ; Endothelium, Vascular/physiology ; Enoxaparin/therapeutic use ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Immunoglobulin Fab Fragments/therapeutic use ; Macrophages/physiology ; Myocardial Infarction/etiology ; Myocardial Infarction/prevention & control ; Platelet Aggregation Inhibitors/therapeutic use ; Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors ; Pravastatin/therapeutic use ; Randomized Controlled Trials as Topic ; Secondary Prevention ; Severity of Illness Index
Chemical Substances	Antibodies, Monoclonal ; Enoxaparin ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Immunoglobulin Fab Fragments ; Platelet Aggregation Inhibitors ; Platelet Glycoprotein GPIIb-IIIa Complex ; C-Reactive Protein (9007-41-4) ; Pravastatin (KXO2KT9N0G) ; Abciximab (X85G7936GV)
Language	English
Publishing date	2003-02-19
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S. ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/s0735-1097(02)02774-2
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Article ; Online: Regadenoson, a selective A2A adenosine receptor agonist, causes dose-dependent increases in coronary blood flow velocity in humans.

Lieu, Hsiao D / Shryock, John C / von Mering, Gregory O / Gordi, Toufigh / Blackburn, Brent / Olmsted, Ann W / Belardinelli, Luiz / Kerensky, Richard A

Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology

2007 Volume 14, Issue 4, Page(s) 514–520

Abstract: Background: Regadenoson is a selective A2A adenosine receptor agonist and vasodilator used to increase the heterogeneity of distribution of coronary blood flow during myocardial perfusion imaging. This study characterized the dose dependence of ... ...

Abstract	Background: Regadenoson is a selective A2A adenosine receptor agonist and vasodilator used to increase the heterogeneity of distribution of coronary blood flow during myocardial perfusion imaging. This study characterized the dose dependence of regadenoson-induced coronary hyperemia. Methods and results: An open-label, dose-escalation study of regadenoson (10-500 microg, rapid intravenous bolus) was performed in 34 subjects; in 4 additional subjects, the effect of aminophylline to reverse the response to regadenoson was determined. Intracoronary peak blood flow velocity in either the left anterior descending or left circumflex artery was measured by continuous Doppler signal recording, heart rate, central aortic blood pressure, and adverse effects were recorded. Regadenoson increased peak blood flow velocity by up to 3.4-fold in a dose-dependent manner. The mean duration of the increase in flow velocity of 2.5-fold or greater caused by 400 to 500 microg of regadenoson was 2.3 to 2.4 minutes. Regadenoson (400-500 microg) increased heart rate by up to 21 +/- 6 beats/min and decreased systolic blood pressure (-5 +/- 8 mm Hg to -24 +/- 16 mm Hg) and diastolic blood pressure (-8 +/- 4 mm Hg to -15 +/- 14 mm Hg). Aminophylline (100 mg) attenuated the increase in peak flow velocity but not tachycardia caused by 400 microg of regadenoson. Conclusion: The results of this study demonstrate the utility of regadenoson as a coronary vasodilator for myocardial perfusion imaging.
MeSH term(s)	Adenosine A2 Receptor Agonists ; Adult ; Aged ; Aminophylline/pharmacology ; Blood Flow Velocity/drug effects ; Coronary Circulation/drug effects ; Dose-Response Relationship, Drug ; Female ; Humans ; Male ; Middle Aged ; Purines/pharmacology ; Pyrazoles/pharmacology ; Tomography, Emission-Computed, Single-Photon/methods ; Ultrasonography, Doppler ; Vasodilator Agents/pharmacology
Chemical Substances	Adenosine A2 Receptor Agonists ; Purines ; Pyrazoles ; Vasodilator Agents ; Aminophylline (27Y3KJK423) ; regadenoson (2XLN4Y044H)
Language	English
Publishing date	2007-07
Publishing country	United States
Document type	Clinical Trial ; Clinical Trial, Phase II ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1212505-2
ISSN	1532-6551 ; 1071-3581
ISSN (online)	1532-6551
ISSN	1071-3581
DOI	10.1016/j.nuclcard.2007.02.016
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Article: Revisiting the culprit lesion in non-Q-wave myocardial infarction. Results from the VANQWISH trial angiographic core laboratory.

Kerensky, Richard A / Wade, Michael / Deedwania, Prakash / Boden, William E / Pepine, Carl J

Journal of the American College of Cardiology

2002 Volume 39, Issue 9, Page(s) 1456–1463

Abstract: Objective: We sought to determine the underlying coronary anatomy and characterize the culprit lesion after non-Q-wave myocardial infarction (NQWMI).: Background: Although the culprit lesion and infarct-related artery often are easily identified with ...

Abstract	Objective: We sought to determine the underlying coronary anatomy and characterize the culprit lesion after non-Q-wave myocardial infarction (NQWMI). Background: Although the culprit lesion and infarct-related artery often are easily identified with coronary angiography after Q-wave MI, the culprit lesion after NQWMI has not been well characterized. Small retrospective studies have suggested that the absence of Q-waves on an electrocardiogram is due to incomplete occlusion of the infarct-related artery. Methods: Coronary angiograms from 350 patients randomized to the early invasive strategy in the Veterans Affairs Non-Q-Wave Infarction Strategies in-Hospital (VANQWISH) trial were systematically analyzed in an angiographic core laboratory. A consensus panel identified the culprit lesion and the infarct-related artery using prespecified criteria for complex lesion morphology and acute versus chronic occlusions. Severity of angiographic disease and left ventricular function also were analyzed. Patients with a single identified culprit lesion were compared with those who had multiple apparent culprits and those without an identifiable culprit lesion. Results: A single culprit lesion was identified in only 49% of patients undergoing early angiography after NQWMI. The majority of patients either had no identifiable culprit (37%) or multiple apparent culprit lesions (14%). A single incomplete occlusion of the infarct-related artery was found in only 36% of patients, and an isolated acute occlusion of the infarct-related artery occurred in 13%. Patients without an identifiable culprit lesion had severe coronary disease (obstructive coronary artery disease [CAD] in 84%) but no complex lesion morphology. There was no difference in angiographic severity of disease comparing patients with and without identifiable culprit lesions. Patients with a single incomplete occlusion of the infarct-related artery were more likely to undergo percutaneous transluminal coronary angioplasty than other patients, whereas patients with multiple culprit lesions were more frequently treated with coronary artery bypass grafting. Conclusions: Coronary angiography early after NQWMI frequently identifies severe obstructive CAD, but a single identifiable culprit lesion was identified in <50% of patients. Multiple culprit lesions were seen in 14% of patients. An angiographic culprit lesion could not be identified in more than one-third of patients undergoing coronary angiography as part of an invasive strategy.
MeSH term(s)	Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease/complications ; Coronary Artery Disease/physiopathology ; Coronary Stenosis/complications ; Coronary Stenosis/diagnostic imaging ; Coronary Stenosis/therapy ; Coronary Vessels/pathology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction/classification ; Myocardial Infarction/diagnostic imaging ; Myocardial Infarction/etiology ; Myocardial Infarction/pathology ; Prospective Studies ; Randomized Controlled Trials as Topic ; Risk Factors ; Severity of Illness Index
Language	English
Publishing date	2002-05-01
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/s0735-1097(02)01770-9
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Article: Systolic compression of the left anterior descending coronary artery: a case series, review of the literature, and therapeutic options including stenting.

Berry, John F / von Mering, Greg O / Schmalfuss, Carsten / Hill, James A / Kerensky, Richard A

Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions

2002 Volume 56, Issue 1, Page(s) 58–63

Abstract: Six cases in our institution of various presentations of left anterior descending (LAD) myocardial bridging were found on coronary angiography. Generally a benign condition, this finding can result in ischemia or infarction as seen in some of our cases. ... ...

Abstract	Six cases in our institution of various presentations of left anterior descending (LAD) myocardial bridging were found on coronary angiography. Generally a benign condition, this finding can result in ischemia or infarction as seen in some of our cases. We found one case in which the bridge resulted in an anterior myocardial infarction in an elderly patient, one case with fixed stenoses at the entry and exit point of the bridge causing ischemia, another with vasospasm within the bridged segment, one case in which the patient was referred for intervention of a fixed stenosis which after intracoronary nitroglycerin (NTG) was found to be an LAD bridge, another case in which the thallium myocardial perfusion scan revealed a reversible anterior defect, and finally one case with anginal chest pain despite a normal coronary flow reserve proximal and distal to the bridged segment. Our treatments varied from stenting in three patients to medical therapy in the remaining patients. We concluded that a thorough evaluation in this population should include functional testing for ischemia, intravascular ultrasound to assess wall thickness, and coronary flow reserve measurements in order to determine the significance of the these bridges. Stenting may have a role in select patients. However, additional studies are needed.
MeSH term(s)	Aged ; Aged, 80 and over ; Arteries/physiopathology ; Arteries/ultrastructure ; Blood Vessel Prosthesis Implantation ; Coronary Angiography ; Coronary Artery Bypass ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/physiopathology ; Coronary Artery Disease/surgery ; Coronary Vessels/diagnostic imaging ; Coronary Vessels/physiopathology ; Electrocardiography ; Female ; Humans ; Male ; Middle Aged ; Stents ; Treatment Outcome ; Ultrasonography, Interventional
Language	English
Publishing date	2002-05
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	1459995-8
ISSN	1522-726X ; 1522-1946
ISSN (online)	1522-726X
ISSN	1522-1946
DOI	10.1002/ccd.10151
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Article ; Online: Some thoughts on the vasculopathy of women with ischemic heart disease.

Pepine, Carl J / Kerensky, Richard A / Lambert, Charles R / Smith, Karen M / von Mering, Gregory O / Sopko, George / Bairey Merz, C Noel

Journal of the American College of Cardiology

2006 Volume 47, Issue 3 Suppl, Page(s) S30–5

Abstract: Considerable experimental and clinical data indicate that sex has an important influence on cardiovascular physiology and pathology. This report integrates selected literature with new data from the Women's Ischemia Syndrome Evaluation (WISE) on vascular ...

Abstract	Considerable experimental and clinical data indicate that sex has an important influence on cardiovascular physiology and pathology. This report integrates selected literature with new data from the Women's Ischemia Syndrome Evaluation (WISE) on vascular findings in women with ischemic heart disease (IHD) and how these findings differ from those in men. A number of common vascular disease-related conditions are either unique to (e.g., hypertensive disorders of pregnancy, gestational diabetes, peripartum dissection, polycystic ovarian syndrome, etc.) or more frequent (e.g., migraine, coronary spasm, lupus, vasculitis, Raynaud's phenomenon, etc.) in women than men. Post-menopausal women more frequently have many traditional vascular disease risk conditions (e.g., hypertension, diabetes, obesity, inactivity, and so on), and these conditions cluster more frequently in them than men. Considerable evidence supports the notion that, with these requisite conditions, women develop a more severe or somewhat different form of vascular disease than men. Structurally, women's coronary vessels are smaller in size and appear to contain more diffuse atherosclerosis, their aortas are stiffer (fibrosis, remodeling, and so on), and their microvessels appear to be more frequently dysfunctional compared with men. Functionally, women's vessels frequently show impaired vasodilator responses. Limitations of existing data and higher risks in women with acute myocardial infarction, need for revascularization, or heart failure create uncertainty about management. A better understanding of these findings should provide direction for new algorithms to improve management of the vasculopathy underlying IHD in women.
MeSH term(s)	Cardiovascular System ; Endothelium, Vascular/physiology ; Female ; Humans ; Muscle, Smooth, Vascular/physiology ; Myocardial Ischemia/physiopathology ; Risk Factors ; Sex Factors
Language	English
Publishing date	2006-02-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	605507-2
ISSN	1558-3597 ; 0735-1097
ISSN (online)	1558-3597
ISSN	0735-1097
DOI	10.1016/j.jacc.2005.09.023
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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

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In stock of ZB MED Cologne/Königswinter

Order via subito