This document summarizes key points from a presentation on ischemic heart disease (IHD) given by Karin H Humphries. It describes differences in IHD between women and men in three main areas: incidence, prevalence and mortality rates of IHD in Canada; pathophysiology of IHD; and differences in management of IHD between women and men. Some key differences highlighted include higher rates of IHD in men compared to women, differences in clinical presentation of acute myocardial infarction between sexes, and impacts of sex on treatment and outcomes of IHD. The presentation concluded that important sex-related differences exist in IHD that are important to consider in clinical assessment and management.

1. Heat Centre Nursing Education Day 2016
Lucy and the
Iceman: Epidemiology of
Ischemic Heart Disease
Karin H Humphries, DSc
UBC-Heart and Stroke
Foundation Professor in
Women’s Cardiovascular Health

2. Objectives
1. Describe the incidence, prevalence and mortality of IHD
in BC/Canada
2. Describe differences in IHD pathophysiology between
women and men
3. Describe differences in management of IHD between
women and for men

3. Incidence, Prevalence,
Mortality of IHD

4. Ischemic Heart Disease in Canada

5. Ishemic Heart Disease in Canada

6. AMI Hospitalization Rates -
BC
J of Women’s Health, 2013; Vol 23, pg1-8

7. Sex Differences in AMI Hospitalization Rates,
by Age and Year

8. Sex Differences in AMI Hospitalization Rates,
by Age and Year

9. IHD Death in Canada

10. IHD Death by Province

11. IHD Death by Country

12. Rotterdam Study-Incidence by Type

13. Sex Differences in
Pathophysiology of IHD?

14. Coronary Microvascular Dysfunction
Camici GB et al. Nature Reviews Cardiology 2015;12:48–62

15. Mechanisms of Myocardial Ischemia
Curr Atheroscler Rep
(2015) 17: 34

16. Admission Diagnosis
STEMI with age in women
with age in men

17. Diagnosis - cTn
Clinical Chemistry 2013;59(7):1099-1107

18. Diagnosis - cTn
Clinical Chemistry 2013;59(7):1099-1107

19. Proportion with Type1 MI
Single Assay 50 ng/L Single Assay 26 ng/L
34 ng/L Men
16 ng/L Women
Shah ASV et al BMJ 2015;350:g7873

20. Sex Differences in
Management?

21. Impact on Treatment/Outcomes
*
*
*
*
*
*
*
Shah ASV et al BMJ 2015;350:g7873

22. Impact on Treatment/Outcomes

23. ACS and Pre-Hospital Delay
Age Group Men Women
< 65 years 160 (84 - 365) 180 (95 - 420) < 0.05
65-74 years 180 (93 - 392) 195 (100 - 435) < 0.05
75-84 years 180 (95 - 392) 191 (100 - 442) < 0.05
> 85 years 177 (90 - 275) 190 (93 - 450) < 0.05
p = 0.17 p < 0.001

24. Use of medications by sex and age group
reference: men <65 years

25. Use of 3+ medications by sex, age, period

26. HORIZONS-AMI Trial
Yu et al. Catheter Cardiovasc Interv 2015; 85:359–368

27. HORIZONS-AMI Trial
Yu et al. Catheter Cardiovasc Interv 2015; 85:359–368

28. Summary
• Important differences exist between women and men in clinical
presentation, and response to treatment for ischemic heart disease
• Behavioural causes of sex-related differences may be more important
than biological factors
• A traditional diagnostic strategies, focusing on coronary obstruction,
and using a single cTn cut-point are likely to be inadequate in women
• Additional testing aimed at determining endothelial coronary
dysfunction may be useful to risk-stratify women with chest pain and
minimal or no obstructive coronary artery disease

29. Thank You