Impaired Coronary Vascular Reactivity and Functional Capacity in Women: Results From the NHLBI Women’s Ischemia Syndrome Evaluation (WISE) Study

Abstract

Objectives: We investigated the relationship between coronary vascular reactivity and functional capacity as assessed from the Duke Activity Status Index (DASI) in a cohort of women evaluated for suspected ischemia. Background: Reduced functional capacity and impaired vascular reactivity are associated with poor prognosis, but an association between vascular reactivity and functional capacity is unknown. Methods: A total of 190 women enrolled in the National Heart, Lung, and Blood Institute (NHLBI)-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study had baseline clinical assessment and coronary artery flow velocity response to adenosine (CFVRado). We compared these results with self-reported DASI metabolic equivalents (METs). Results: Mean age was 55 ± 11 years (range 21 to 83 years), and only 18% had coronary stenosis ≥50%. Women with a CFVRado<2.5 (n = 98) had mean DASI of 15.1 ± 13.6, compared to women (n = 92) with CFVRado≥2.5, whose mean DASI was 21.0 ± 15.2 (p = 0.004). This relationship was maintained after adjusting for age and presence of coronary artery disease. CFVRadoof ≥2.5 was associated with a DASI of >20 (odds ratio 3.03, 95% confidence interval 1.56 to 5.90, p = 0.001). Conclusions: Women with reduced CFVRadowere significantly more likely to have reduced functional capacity. Impairment in coronary vascular function and reduced levels of activity may both play a role in the poorer prognosis observed in the WISE study women; however, the relationship between the two is still unclear.