Are we ‘WISE’r? Findings from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation Study

Recognition of cardiovascular disease as the leading healthcare threat to women continues to shape the prioritization of efforts to more effectively diagnose and treat heart disease in women. At its inception almost 8 years ago, the National Heart, Lung and Blood Institute in the USA sponsored the Women's Ischemia Syndrome Evaluation (WISE) study, aiming to optimize symptom evaluation and diagnostic testing for ischemic heart disease in women and to explore pathophysiologic mechanisms for symptoms and myocardial ischemia in the absence of epicardial coronary artery stenosis. The WISE study has investigated the spectrum of anginal symptoms, diagnostic strategies for micro- and macrovascular coronary disease, and the role of psychosocial variables and reproductive hormones in ischemic heart-disease presentation. One of the pivotal WISE findings sheds light on chest pain in the absence of significant obstructive epicardial luminal coronary stenosis, otherwise known as Cardiac Syndrome X. In the WISE study, using coronary vasomotor testing during angiography, investigators observed prevalent abnormalities in coronary flow reserve, suggestive of microvascular coronary dysfunction in relation to adverse morbidity and mortality among these women. Findings such as these from the WISE study have significantly added to the current management approach to heart disease in women.