January 31, 2006
(The New York Times News Service) -- Standard diagnostic testing can miss the warning signs of heart disease in women, a large U.S. government study suggests.
This is because plaque tends to collect in the smaller vessels in women, while it builds up in the major arteries in men.
Unfortunately, routine angiographies tend to pick up only significant blockages in major arteries, according to results from the National Institutes of Health-sponsored Women's Ischemia Syndrome Evaluation study, initiated in 1996 to look at heart disease in women.
As many as 3 million U.S. women may have this condition, called coronary microvascular syndrome, which puts them at an increased risk of heart attack and even death, experts say.
"This just increasingly validates that we're learning more and more about women every day, and that it calls for a mechanism of heart disease that frequently goes undiagnosed," says Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York City and author of "The Women's Healthy Heart Program."
"Women and physicians should pay attention to symptoms related to the heart," adds Dr. George Sopko, Women's Ischemia Syndrome Evaluation project officer for the National Heart, Lung and Blood Institute. The study appears as a special supplement to the Feb. 6 issue of the Journal of the American College of Cardiology, and is available online on Jan. 31.
Ischemic heart disease is the leading cause of death in the United States, with women bearing a disproportionate burden of the illness. Some 250,000 women die each year from IHD and its related conditions, the report says. More than two-thirds (38 percent) of all deaths in women are related to coronary heart disease. And, since 1984, more women than men have died each year from IHD. IHD is the leading killer of women of all ages, the report added.
Yet traditional disease management seems to overlook problems in women. In particular, coronary angiography, an X-ray examination of the blood vessels and chambers of the heart, is not specific enough to detect problems in women, the researchers said.
"The coronary angiogram provides anatomical information about the location of the blockages, and how much they block," Sopko says. "The angiogram doesn't provide information about what happens within the wall."
Women's Ischemia Syndrome Evaluation investigators found that a majority of women who were given an all-clear on their angiograms continued to have symptoms, along with repeated testing and hospitalizations and a declining quality of life.
"We found that women who have no significant blockages but have evidence of ischemia are at a high risk for future heart attacks, repeat hospitalization or even death," Sopko says. "That was noted in small studies before, but nobody had such a big cohort."
"When women go for an angiogram and they don't find blockages, it doesn't mean they don't have a problem. It means the problem's not caused by buildup of plaque," Goldberg says. "It doesn't mean that the symptoms aren't coming from the heart. They can come from very small blood vessels that we don't see in standard testing."
The question: What do you do in women who have symptoms but no significant blockages?
The answer: Don't ignore the problem.
"This is looking at women who might have been discarded. Now we're saying, you don't have the big blockages, but you've got some problems, so let's go look," Sopko says. "You don't neglect or deny medical therapy to these women."
An added problem, however, is that there isn't much nonstandard testing to detect these kinds of problems, Goldberg says.
"Unfortunately, for this particular mechanism, we don't yet have all the tools we need," he notes. "Clearly, when it comes to women and heart disease, we can't take for granted that it's going to be exactly to the same script as men."
Copyright 2006 The New York Times News Service. All rights reserved.