2nd Day-1st Talk: "Women and Coronary Heart Disease” By Thomas J. Stegmann, MD, PhD

Dr. Thomas Stegmann is the Co-Founder, Co-President and Chief Medical Officer of CardioVascular BioTherapeutics, Inc. In 2007 he wrote “Holding a Woman’s Heart in My Hands” which discusses the uniqueness of heart disease in women, and how angiogenesis could be a more effective treatment. He was the former Director of the Department for Thoracic and Cardiovascular Surgery at the Fulda Medical Center in Germany. Dr. Stegmann joined us to discuss exciting new treatments for women who are affected by coronary heart disease.

All societies in the western world are more and more afflicted with heart disease. Heart disease (CVD) is the leading cause of death in American women, accounting for 37.7 percent of all deaths per year. More than 459,000 women in America die every year from cardiovascular disease. 8 million American women are currently living with heart disease, and of those, 6 million have a family history of heart disease. Fewer than half of all women are aware that heart disease is the number one killer of American women. Most women identify cancer as the leading cause of death. Interestingly, in the United States, all cardiovascular disease combined claim the lives of more women every year that the next 16 causes of death combined and almost twice as many as all forms of cancer. One in six women will die from heart disease, while one in 30 women will die from breast cancer. Every year since 1984, more women than men have died of cardiovascular disease.

There are more difficulties related to women’s coronary heart disease than in men primarily because men have larger coronary arteries. There are also differences in outcome related to the first heart attack. Studies have shown a two-fold increase of morbidity in women suffering a myocardial infarction ages 35-44.

Women can have a pattern of coronary heart disease known as cardiac syndrome x. Some of the classic symptoms of cardiac symptom x include: predominantly effort induced angina, ST segment depression suggestive of myocardial ischemia during spontaneous or provoked angina, normal coronary arteries at angiography, absence of spontaneous or provoked epicardial coronary artery spasm, and the absence of cardiac or systemic disease potentially associated with microvascular dysfunction. The new set of symptoms that define cardiac x syndrome include: stable angina, findings compatible with myocardial ischemia/ coronary microvascular dysfunction on diagnostic investigation (i.e. ECG, SPECT, MRI, PET, Doppler), normal coronary arteries at angiography, and an absence of any other specific cardiac disease. Some of the players of CAD in women include: low estrogen level, impaired vasodilation, increased vasoconstriction, and low-grade inflammation.

There are a number of diagnostic tools that can be used to diagnose cardiac syndrome x, such as: baseline ECG, exercise ECG (stress test), exercise radioisotope test (nuclear stress test or myocardial scintigraphy), echocardiography, coronary angiograhy, intravascular ultrasound, and an MRI scan. Dr. Stegmann discussed some treatment options to treat cardiac syndrome x: β-blockers, nitrates, calcium antagonists, xanthine derivatives, analgetics, estrogens, α-antagonists, ACE-inhibitors, and possibly statins and spinal cord stimulation. However, Dr. Stegmann discussed a novel technique as a treatment option for coronary heart disease in women: FGF-1 induced angiogenesis. The FGF is administered via a NOGA-guided transcendocardial injection, and the theory is the FGF stimulates a microvascular environment. Dr. Stegmann believes this is a new horizon for this disease in both men and women.