Women’s Health – ABC CARDIOL

IJCS

Viewpoint

New Insights Into Ischemic Heart Disease in Women: The Central Role of Coronary Microvascular Dysfunction Current Insights, Diagnostic Advances, And Therapeutic Uncertainties

Elizabeth Regina Giunco Alexandre et al. Isabelle Salomão Larissa Neto-Espíndola Rafaela Penalva … Mayara Lídia Da Silva Claudio Tinoco Mesquita

Introduction

This viewpoint discusses emerging evidence and the clinical implications of coronary microvascular dysfunction (CMD) in women, offering a focused perspective on pathophysiologic, diagnostic, and therapeutic features that distinguish ischemic heart disease (IHD) in women from that in men. Beyond summarizing available data, we highlight the growing body of evidence supporting CMD as an important and often underrecognized contributor to ischemic symptoms and cardiovascular risk in women. We emphasize key concepts and ongoing controversies without intending to provide definitive therapeutic recommendations.

Ischemic heart disease (IHD) remains a leading cause of morbidity and mortality worldwide. Recent evidence also highlighted sex-based differences in ischemic pathophysiology and vascular aging in women.

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IJCS

Brief Communication

Prevalence of Subclinical Left Ventricular Dysfunction Evaluated by Global Longitudinal Strain in Female Carriers of Duchenne Muscular Dystrophy

Eduarda Vieira Rodrigues et al. Antonio Pedro Lima Costa Pereira Wilson Braz Correa Filho Maria Angelica de Faria Domingues de Lima … Marcio Aloysio Freitas Siqueira Junior Ana Paula Cassetta dos Santos Nucera Fabio de Souza

Abstract

Duchenne muscular dystrophy (DMD) is a muscular disease genetically linked to the DMD gene, which encodes dystrophin, a protein that is crucial for the integrity of skeletal muscle and myocytes. This condition follows an X-linked inheritance pattern. Female carriers are typically asymptomatic; however, they may develop cardiomyopathy, making screening for structural heart disease advisable. We conducted a cross-sectional study to assess the prevalence of subclinical left ventricular (LV) dysfunction, defined by reduced global longitudinal strain (GLS), in asymptomatic female DMD carriers. Participants underwent 2-dimensional speckle tracking echocardiography following a standardized protocol, with GLS values ≤ 18% classified as reduced. Continuous variables were described as mean ± standard deviation and categorical variables as percentages. The association between left ventricular ejection fraction (LVEF) and GLS was assessed using Pearson’s correlation coefficient. The significance level adopted was 5%. Using a convenience sample, 17 participants (mean age 39 ± 5 years) were enrolled. No significant changes were observed in LV diameters, and the mean LVEF was 62% ± 5%. Reduced GLS was identified in 3 participants, indicating a prevalence of 17.6% for subclinical LV dysfunction. A weak correlation was found between GLS and LVEF (r = 0.366). Our findings indicate that approximately 1 in 6 female DMD carriers had subclinical LV dysfunction. These results highlight the need for genetic counseling for mothers of patients with DMD, as well as early screening with sensitive methods to detect heart disease in female DMD carriers.

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IJCS

Editorial

Are Women the Fragile Sex? Or are They the Singular Sex?

Celi Marques-Santos et al. Gláucia Maria Moraes de Oliveira

Women need specific intervention and information about their particularities, especially regarding CV risk factors, as well as the biological, pathophysiological, and social differences between the sexes. The majority of large clinical trials that address current cardiovascular diseases (CVD) were not conducted with enough women to generate robust evidence. CVD in women remains poorly studied, poorly recognized, underdiagnosed, and undertreated, generating worse outcomes. It is necessary to change this reality so that women are approached according to their singularities in order to reduce the burden of CVD by 2030.

Among the CV risk factors in Brazilian women, arterial hypertension, dietary risks, obesity, increased serum cholesterol, and fasting glucose stand out. Sex-related CV risk factors, which affect CVD throughout life, play a crucial role in women. Menopause, especially in women 40 years, promotes changes in body composition, with an increase in fat mass and a greater probability of metabolic syndrome.^, Hypertensive diseases of pregnancy, such as pre-eclampsia, gestational diabetes, and premature birth, increase CVD in adulthood. The use of contraceptive hormones associated with arterial hypertension increases the risk of myocardial infarction (MI) by 12 times. Polycystic ovary syndrome and autoimmune diseases contribute to increased cardiovascular risk.

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New Insights Into Ischemic Heart Disease in Women: The Central Role of Coronary Microvascular Dysfunction Current Insights, Diagnostic Advances, And Therapeutic Uncertainties

Introduction

Prevalence of Subclinical Left Ventricular Dysfunction Evaluated by Global Longitudinal Strain in Female Carriers of Duchenne Muscular Dystrophy

Abstract

Are Women the Fragile Sex? Or are They the Singular Sex?

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