In the past decade, our understanding of sex- and gender differences in cardiovascular diseases (CVD) has considerably improved. However, relevant evidence is scattered throughout the medical literature. There is a need to make this information easily accessible to health care professionals, scientists, policy makers and patients. Implementation of existing knowledge in clinical practice will then be promoted, knowledge gaps identified, and policy makers informed on the areas that need additional attention. Against this background, the IMPRESS consortium will raise a Knowledge Platform that gathers, summarizes and prioritizes existing knowledge on sex- and gender aspects of CVD.
Previous research and practical experience show that many women present with symptoms that are unclear as to whether they are a manifestation of heart disease. For example, suggestive symptoms could also fit well with general menopausal symptomatology. General practitioners face the challenge to determine who should be referred for further investigation by a cardiologist. Since diagnostic tools are limited in the general practitioner setting, under-recognition and untimely diagnosis of coronary artery disease (CAD) might occur. We will investigate whether and how the diagnostic process in women with symptoms of heart disease can be improved. We will pay attention to physical, psychosocial, and ethnic-cultural aspects. We will also undertake biobank studies to identify mechanisms of accelerated atherosclerosis in young women.
In substantial portions of women with symptoms of myocardial ischemia, obstructive disease in the epicardial coronary arteries is absent. Currently, such women undergo multiple diagnostic tests, which do not always result in a conclusive diagnosis. Early studies report a high prevalence of microvascular angina (MVA) and vasospastic angina (VSA) in this population, but consistent prevalence numbers in the Netherlands are lacking. Patients with MVA/VSA angina have an impaired quality of life and a poorer prognosis than those without CAD. IMPRESS will conduct research into women (and men) who have a diagnosis of non-obstructive CAD and yet remain symptomatic. We will extend an existing national registry to investigate current care of these patients and perform invasive catheterization as well as non-invasive methods to identify MVA/VSA. Finally, we will study pharmacological interventions aimed to relieve symptoms in subjects with MVA/VSA.
Eric Boersma - Principal Investigator
Hester den Ruijter - Principal Investigator
Projectmanager: Fleur Meijers - Fleur.Meijers@heart-institute.nl
We hypothesize that:
- Current decision support tools do not perform well in the younger female CAD population with symptoms who present to the general practitioner.
- Features from a large volume of healthcare data on CAD in younger women can aid in early detection of CAD.
- Accelerated atherosclerosis in younger women (with preeclampsia as a high-risk group) is caused by immune-mediated endothelial cell dysfunction.
- Performing systematic interventional diagnostic procedures (IDPs) in women with persistent sign and symptoms of ischemia gives insight into the prevalence and outcomes of MVA/VSA/mixed phenotype.
Our short-term ambitions are:
- To create a Knowledge Platform that provides evidence-based information and knowledge gaps on the topic of cardiovascular disease in women. The Knowledge Platform should be easily accessible for target audience. We will measure success by using online tools that quantify the number of visits to the online platform and ask for regular feedback of the target audience on the online platform.
- To create a decision support tool that aids in the identification of (young) women with CAD in primary care.
- Identify mechanisms of accelerated atherosclerosis in women of younger age with former preeclampsia (as high-risk group representative for younger women with CAD).
- To perform IDPs to identify women with MVA/VSA/mixed phenotype and test which non-invasive tools show high correlations with MVA/VSA.
- To aid in implementation of scientific evidence on improvement of cardiovascular diagnosis and care for women.
Our long-term ambition is to reduce missed and delayed diagnosis of heart diseases in women. As important spin-off, this effort will not only improve cardiovascular care for women directly, but also connects ongoing research efforts on CVD in women. Our ambition for the Knowledge Platform is that it will be the leading national platform for information on sex and gender in CVD for policy makers, researchers and patient groups and has a sustainable long-term business case. It should integrate ongoing efforts to improve cardiac care for women and facilitate collaborations with stakeholders such as the Dutch society of Cardiology (NVVC). The platform also has the ambition to identify information on sex and gender in CVD that is implementation-ready. Hence, it supports early implementation of available evidence on sex- and gender sensitive cardiovascular medicine.
Hester den Ruijter
Jeanine Roeters van Lennep
Saskia de Jager
Bas van Rijn
Ysette de Boer
Julianne van Oortmerssen
Dinah van Schalkwijk
Vanessa van Empel
Niels van Royen
- The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030: https://pubmed.ncbi.nlm.nih.gov/34010613/
- The importance of achieving sex- and gender-based equity in clinical trials: a call to action: https://pubmed.ncbi.nlm.nih.gov/34352884/
- Heart failure medication dosage and survival in women and men seen at outpatient clinics: https://pubmed.ncbi.nlm.nih.gov/34261736/
- Persistent Symptoms and Health Needs of Women and Men With Non-Obstructed Coronary Arteries in the Years Following Coronary Angiography: https://pubmed.ncbi.nlm.nih.gov/34012986/
- Sex Differences in Coronary Function Test Results in Patient With Angina and Nonobstructive Disease: https://pubmed.ncbi.nlm.nih.gov/34722680/
- Vasomotor dysfunction in patients with angina and nonobstructive coronary artery disease is dominated by vasospasm: https://pubmed.ncbi.nlm.nih.gov/33711394/
- Features of atherosclerosis in patients with angina and no obstructive coronary artery disease: https://pubmed.ncbi.nlm.nih.gov/35082112/
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- Diagnostic approach in patients with angina and no obstructive coronary artery disease: emphasising the role of the coronary function test: https://pubmed.ncbi.nlm.nih.gov/33415605/
- Relation Between Coronary Tortuosity and Vasomotor Dysfunction in Patients Without Obstructed Coronaries? https://pubmed.ncbi.nlm.nih.gov/35097023/
- College universiteit van Nederland: https://www.universiteitvannederland.nl/college/hoe-kan-je-ongemerkt-een-hartaanval-hebben
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