Henrik Engblom
The mystery of female coronary artery disease - the role of sex hormones in myocardial perfusion and prognosis
- Why do women develop coronary heart disease 10-15 years later in life than men?
- Why do women undergo more unnecessary coronary interventions than men?
We currently do not have answers to these questions because our knowledge of the heart and its coronary arteries is mainly based on studies carried out on men in the last century. We want to change this with the proposed project.
Our research group is a world leader in the imaging and calculation of myocardial perfusion using magnetic resonance imaging. We therefore want to use this technique to study how female sex hormones affect the blood supply to the heart muscle, both in young healthy fertile women and in post-menopausal women treated with hormone therapy for menopausal symptoms.
We also want to study how gender and sex hormones affect the diagnosis and prognosis of patients with angina, and whether women and men receive the same medical care for coronary artery disease.
By increasing knowledge about gender differences both in the healthy female heart and in coronary artery disease, we hope to improve both assessment and treatment for both women and men. Increased knowledge in the field would provide better conditions for more individualized healthcare for patients with angina. We thus hope to contribute to improving both quality of life and prognosis in this large patient group.
References
1. Székely A, Steding-Ehrenborg K, Ryd D, Hedeer F, Valind K, Akil S, Hindorf C, Hedström E, Erlinge D, Arheden H, Engblom H. Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study. Clin Physiol Funct Imaging 2024 Jan;44(1):89-99.
This work highlights the effect of gender on myocardial perfusion in relation to the degree of coronary stenosis.
2. Gyllenhammar T, Carlsson M, Jögi J, Arheden H, Engblom H. Myocardial perfusion by CMR coronary sinus flow shows sex differences and lowered perfusion at stress in patients with suspected microvascular angina. Clin Physiol Funct Imaging. 2022 May;42(3):208-19.
This work shows significant sex differences in myocardial perfusion both in healthy controls and in patients with coronary artery disease, as well as in patients with suspected small vessel disease of the heart muscle.
3. Nordlund D, Engblom H, Bonnet J-L, Hansen HS, Atar D, Erlinge D, Ekelund U, Heiberg E, Carlsson M, Arheden H. Gender but not diabetes, hypertension or smoking affects infarct evolution in ST-elevation myocardial infarction patients - data from the CHILL-MI, MITOCARE and SOCCER trials. BMC Cardiovasc Dis 2019;19:161.
This study shows that infarct development is more influenced by gender than by smoking, diabetes and hypertension.
4. Akil S, Heden B, Pahlm O, Carlsson M, Arheden H, Engblom H. Gender aspects on exercise-induced ECG changes in relation to scintigraphic evidence of myocardial ischaemia. Clin Physiol Funct Imaging 2018;38:798-807.
This article highlights existing gender differences in the diagnosis of coronary artery disease. The results provide the basis for further exploration of the pathophysiological mechanisms underlying sex differences in vasospasm.
5. Engblom H, Xue H, Akil S, Carlsson M, Hindorf C, Oddstig J, Hedeer F, Hansen MS, Aletras AH, Kellman P, Arheden H. Fully quantitative cardiovascular magnetic resonance myocardial perfusion ready for clinical use: a comparison between cardiovascular magnetic resonance imaging and positron emission tomography. J Cardiovasc Magn Reson 2017;19:78.
This work presents the first validation of quantitative measurements of myocardial perfusion by MRI. This article was named "Article of the Year 2017" in the Journal of Cardiovascular Magnetic Resonance.