Coronary Microvascular Dysfunction and Estrogen Receptor Signaling

Chest pain, in the absence of obstructive coronary artery disease (NOCAD), occurs more frequently in women than in men since changes in micro/macro-circulation are often estrogen-dependent. Despite having ischemia, patients with coronary microvascular disease (CMD) are often discharged without a clear treatment plan due to lack of a clear understanding of etiology and diagnostic parameters of this disease. The causes of CMD can be heterogeneous, and their effects on the microvascular angina are poorly understood. Currently, there is no consensus definition of CMD. CMD is more frequent in postmenopausal women than in premenopausal women and these patients are more likely to experience a cardiovascular events within the first year compared with men. Estrogens might offer a novel way to prevent and treat CVD in women without prior risk and estrogen signaling needs to be further studied in the context of CMD. Chest pain with non-obstructive coronary artery disease (NOCAD) occurs more frequently in women than in men and is mainly related to coronary microvascular disease (CMD). The majority of CMD patients are postmenopausal women, suggesting a role for lack of estrogens in the development and progression of CMD. Patients are often discharged without a clear treatment plan due to the limited understanding of etiology and diagnostic parameters of CMD and have significantly higher rates of future cardiovascular events. Thus, there is a need for a better understanding of the underlying biology, and CMD-specific diagnostic tests and therapies. In this article, we reviewed recent studies on CMD, estrogen action in coronary microvasculature, and diagnosis and treatment options for CMD in postmenopausal women. Chest pain with non-obstructive coronary artery disease (NOCAD) occurs more frequently in women than in men and is mainly related to coronary microvascular disease (CMD). The majority of CMD patients are postmenopausal women, suggesting a role for lack of estrogens in the development and progression of CMD. Patients are often discharged without a clear treatment plan due to the limited understanding of etiology and diagnostic parameters of CMD and have significantly higher rates of future cardiovascular events. Thus, there is a need for a better understanding of the underlying biology, and CMD-specific diagnostic tests and therapies. In this article, we reviewed recent studies on CMD, estrogen action in coronary microvasculature, and diagnosis and treatment options for CMD in postmenopausal women.