Heart Disease Often Undiagnosed in Women, Study Finds

[CAL/AAEM News Service]

Heart Disease Often Undiagnosed in Women, Study Finds

Source: California Healthline (http://www.californiahealthline.org) 
Date: February 1, 2006
 

As many as three million women in the U.S. might have a cardiovascular
condition called coronary microvascular syndrome that places them at higher
risk of a heart attack but often goes undiagnosed because its symptoms do not
appear on an angiogram, according to research released on Tuesday by NIH, the
Chicago Tribune reports (Peres, Chicago Tribune, 2/1). The leading cause of
death in the U.S., heart disease kills about 480,000 women annually, and more
women than men die of the disease, according to the American Heart Association
(Neergaard, AP/Oregonian, 1/31).

The new findings, which appear in several papers to be published in a
supplement to the Feb. 7 issue of the Journal of the American College of
Cardiology, are the latest results released from the ongoing Women's Ischemia
Syndrome Evaluation (Stein, Washington Post, 2/1). The WISE study began in 1996
and tracks about 1,000 women with the goal of improving diagnosis and expanding
understanding of heart disease in women (Rubin, USA Today, 2/1).

The participants -- who live in Florida, Pennsylvania and Alabama -- were
enrolled after they experienced chest pain and other symptoms of heart disease
but showed no evidence of blockage in an angiogram (Maugh, Los Angeles Times,
2/1). Their average age was about 58, although one quarter of participants were
premenopausal (Grady, New York Times, 2/1).


Findings
According to the research, coronary microvascular syndrome accounts for about
15% of all coronary artery disease in women, Noel Bairey Merz, a cardiologist
at Cedars-Sinai Medical Center and chair of WISE, said (Los Angeles Times,
2/1). In the condition, plaque accumulates fairly evenly inside the major
arteries and smaller blood vessels, or the arteries fail to expand correctly or
go into spasm, the findings show. Other symptoms include fatigue, upset stomach
and pain in the jaw or shoulders. However, because many women with symptoms do
not show signs of blocked arteries on standards tests, doctors sometimes "send
them home without treatment or refer them to psychiatrists," according to the
Post. Further, the findings show that women who do receive treatment for heart
disease might not benefit from standard drugs, bypass surgery, angioplasty or
other conventional therapies (Washington Post, 2/1).

However, as with arterial blockages, the plaques formed in coronary
microvascular syndrome can interfere with blood flow and damage the heart
muscle, leading to ischemic heart disease, a condition characterized by
inadequate blood flow to the heart. According Carl Pepine, chief of
cardiovascular medicine at the University of Florida and a lead investigator in
WISE, the results show:

One-third of participants had obvious blockages in their arteries. By
comparison, about three-quarters of men in a group similar to the study
participants would have blockages.

Of participants without obvious blockages, more than half had abnormalities
that could cause ischemic heart disease.

After four years, the rate of deaths or heart attacks among participants
without obvious blockages was 10%, "much too high for somebody with a normal
coronary angiogram," according to Pepine.

Tests on study participants indicated that the artery walls were full of plaque
but had expanded to accommodate it, resulting in an opening that appeared
normal (New York Times, 2/1).



Recommendations
The researchers included a number of recommendations in their reports. The
recommendations included:
Women with symptoms of cardiovascular disease should be administered a test of
functional capacity, such as the Duke Activity Status Index, a 12-item
questionnaire evaluating difficulties performing everyday activities.

Doctors should avoid treadmill tests, which fail to identify 40% of women with
ischemic heart disease, and opt for more sophisticated stress tests and
chemical stress tests.

Premenopausal women with high blood pressure and overweight women of all ages
should be considered at high risk of heart problems (Chicago Tribune, 2/1).


Comments, Additional Recommendations
The researchers said it is unclear why women are more likely to have hidden
heart disease than men, although they speculated it could be related to
hormonal imbalances and a greater likelihood to experience inflammation (New
York Times, 2/1). Bairey Merz said, "What we're saying is that in many cases
heart disease is a fundamentally different disease in many women in ways that
we need to pay attention to" (Washington Post, 2/1). She added, "One of the
biggest take-home messages from this study is that we must stop falsely
reassuring women when their arteries are open" (Los Angeles Times, 2/1). Bairey
Merz noted that coronary microvascular syndrome "appears to be primarily a
women's problem which is probably why we've missed it all these years (that) we
didn't bother to study women." About 20% of individuals with coronary
microvascular syndrome are men, she said.

George Sopko, a project officer for WISE and a heart specialist at the National
Heart, Lung and Blood Institute, said, "The [number one] message for women is,
'Pay attention to your symptoms.' If you don't have visible blockages, that
doesn't mean you're not at risk" (AP/Oregonian, 2/1). Sopko said the message
for doctors is, "If you have (a patient with) symptoms and evidence of
ischemia, even if the angiogram doesn't show significant blockage, you don't
send her home. You treat her as a patient at higher risk." He also recommended
that doctors develop a long-term strategy for treatment -- including
encouraging patients to increase activity, quit smoking, lose weight and
improve lipids and blood pressure. Sopko said researchers are "not yet ready to
change the treatment guidelines, but at least now we can tell [patients] what
the problem is, even if we don't yet have the best therapies" (Chicago Tribune,
2/1). 


For more information, please visit:
http://www.californiahealthline.org/index.cfm?Action=dspItem&itemID=118416 




Cyrus Shahpar & Brian Potts 
Managing Editors, CAL/AAEM News Service
University of California, Irvine

The CAL/AAEM Archives are available at: http://maillists.uci.edu/mailman/public/calaaem/


__________________________________________________
Do You Yahoo!?
Tired of spam?  Yahoo! Mail has the best spam protection around 
http://mail.yahoo.com