CARDIOVASCULAR JOURNAL OF AFRICA • Volume 25, No 3, May/June 2014
AFRICA
137
Review Article
Novel cardiovascular risk markers in women with
ischaemic heart disease
Dana Pop, Alexandra Dădârlat, D Zdrenghea
Abstract
The incidence of coronary heart disease in premenopausal
women is lower than in men because of their hormonal
protection. Angina pectoris occurs in women about 10 years
later than in men. However, mortality from ischaemic heart
disease remains higher in women than in men. Current stud-
ies are focusing on novel cardiovascular risk biomarkers
because it seems that traditional cardiovascular risk factors
and their assessment scores underestimate the risk in females.
Increased plasma levels of these newly established biomark-
ers of risk have been found to worsen endothelial dysfunc-
tion and inflammation, both of which play a key role in the
pathogenesis of microvascular angina, which is very common
in women. These novel cardiovascular risk markers can be
classified into three categories: inflammatory markers, mark-
ers of haemostasis, and other biomarkers.
Keywords:
ischaemic heart disease, women, new cardiovascular
risk factors
Submitted 4/12/13, accepted 14/3/14
Cardiovasc J Afr
2014;
25
: 137–141
DOI: 10.5830/CVJA-2014-014
Cardiovascular disease (CVD) represents the leading cause of
death among women in Europe. About 53% of female deaths
are due to CVD, particularly coronary heart disease and stroke.
1-9
The incidence of coronary heart disease is significantly lower
in premenopausal women, due to their hormonal protection,
but there are reportedly more complex mechanisms involved.
Angina pectoris and heart attack occur in women about 10 and
20 years, respectively, later than in men.
5
There are significant gender-related differences concerning
coronary heart disease. The particularities regarding women
are: higher prevalence in women over 75 years, the first
coronary event is 10 years later than in men, atypical symptoms,
high incidence of non-Q-wave myocardial infarction, and the
prevalence of coronary arteries without angiographic findings is
twice as common as in men.
6
Since 2004, guidelines have been emphasising the importance
of recognising cardiovascular risk factors in women and also to
classify women at high, intermediate or ‘ideal’ cardiovascular
risk.
2-4
A high-risk status is given not only by the presence of
coronary artery disease, cerebrovascular disease, chronic arterial
occlusive disease, aortic aneurysm or a Framingham score over
10%, but also by the presence of chronic kidney disease or
diabetes.
2
Women who face the threat of cardiovascular disease
present with one or more risk factors including: smoking,
pro-atherogenic diet, obesity (especially central obesity), family
history of cardiovascular disease at a young age, hypertension
and dyslipidaemia. Furthermore, it seems that subclinical
vascular disease (such as coronary calcification), the metabolic
syndrome, a low effort capacity or an abnormal heart rate
recovery after the exercise stress test creates a prominent
cardiovascular risk among women.
2
Latest studies show that
women diagnosed with collagen disease (auto-immune disease),
a history of pre-eclampsia, gestational diabetes or pregnancy-
induced hypertension require strict medical management due to
their high predictive ability for the development of cardiovascular
disease.
2
Ideal cardiovascular health status is gained by women with
blood pressure below 120/80 mmHg, total cholesterol level
below 200 mg/dl, fasting plasma glucose below 100 mg/dl
(without specific treatment), body mass index (BMI) below 25
kg/m
2
and, undoubtedly, by those who practice intense physical
exercise at least 150 minutes per week, or moderate exercise for
75 minutes per week, and by non-smoking women.
2
Review of the evidence reveals that compilation of traditional
risk factors and cardiovascular risk scores underestimates the risk
in women. Therefore, ongoing areas of research are focusing on
novel markers of cardiovascular risk. These novel cardiovascular
risk biomarkers have been selected because their increased
plasma levels worsen endothelial dysfunction and inflammation,
both being key players in the pathogenesis of microvascular
angina, which is a common phenomenon in women.
1
The Women’s Health Initiative hormone trials showed that at
least 18 new biomarkers are useful in estimating cardiovascular
risk in postmenopausal women. These are lipoprotein (a),
homocysteine, insulin, C-reactive protein (CRP), E-selectin,
interleukin-6, matrix metalloproteinase-9, fibrin D-dimer, factor
VIII, plasminogen activator inhibitor-1 antigen, prothrombin
fragment 1.2, plasmin–antiplasmin complex, thrombin-
University of Medicine and Pharmacy Iuliu Haţieganu,
Cluj-Napoca, Romania
Dana Pop, MD
Alexandra Dădârlat,
D Zdrenghea, MD
