Women's heart disease: New study shows differences

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Women's heart disease:  New study shows differences

Women's heart disease: Learn the latest on risk, symptoms and treatment in women.

Just because your arteries appear clear on an angiogram, it doesn't mean you're not at risk of heart disease. And the sage advice often given to men with heart disease might need a tweak or two to be useful in women.

As many as 3 million women previously diagnosed with healthy arteries could actually have an increased risk of heart attack after all, according to a study of women and heart disease by the National Institutes of Health. The study, called WISE, short for Women's Ischemia Syndrome Evaluation, found among other things that the gold standard test for assessing coronary artery disease — the coronary angiogram — may not spot the more diffuse buildup of plaques that often forms in the smaller coronary arteries of women's hearts.

"This study is very important. It's the first time we've looked at just women with chest pain," said Sharonne Hayes, M.D., a cardiologist at Mayo Clinic, Rochester, Minn., and review board member for this study.

Historically, coronary artery disease has been considered primarily a man's disease. But recent statistics have shown that the rate of heart disease has declined in men but not in women. This is, at least in part, because of gender differences in risk factors, symptoms and diagnostic accuracy. Tests and treatments for cardiovascular disease have been primarily studied in men. Researchers have now confirmed what's long been suspected, women are different.

With this news in hand, what can you do about it?

Know your risk factors

By putting more emphasis on treating risk factors, women may more effectively lower their risk of heart attack.

"Although the traditional risk factors for coronary artery disease —such as high cholesterol, high blood pressure and obesity — have a detrimental impact in men and women, certain factors may play a bigger role in the development of heart disease in women," according to Amir Lerman, M.D., a cardiologist at Mayo Clinic, Rochester, Minn., and one of the WISE investigators. For example:

  • Metabolic syndrome — a combination of increased blood pressure, elevated blood glucose and triglycerides — has a greater impact on women than men.
  • Mental stress and depression affect women's hearts more than men's.
  • Smoking is much worse for women than men.
  • Low levels of estrogen before menopause is a significant risk factor for developing microvascular disease.

See your doctor

"Women need to be more vigilant about recognizing and treating their risk factors. You shouldn't wait until you've been diagnosed with an artery blockage or have symptoms. If you have significant risk factors for coronary artery disease, see your doctor," says Dr. Hayes.

The typical tests for coronary artery disease — angiogram, treadmill testing and others — may leave some women with a false sense of security. The WISE study showed that in some women, plaques accumulate as an evenly spread layer along artery walls, which is not visible using traditional testing methods designed to identify the bulky, irregular, not-so-subtle plaques in men's arteries.

Know the symptoms

"Though women will often have some chest pain or discomfort, it may not be the most prominent symptom," says Dr. Hayes.

Diffuse plaques buildup and diseased smaller arteries are two reasons why symptoms can be different in women.

In addition to chest pain, pressure or discomfort, signs and symptoms of heart attack in women include:

  • Neck, shoulder, upper back or abdominal discomfort
  • Shortness of breath
  • Nausea or vomiting
  • Sweating
  • Lightheadedness or dizziness
  • Unusual fatigue

These signs and symptoms are more subtle than the obvious crushing chest pain often associated with heart attacks. This may be due to the smaller arteries involved or because in men, the bulky, unstable plaques tend to burst open whereas in women, plaques erode, exposing the inner layers of the artery.

Differences in symptoms may also relate to a condition called endothelial dysfunction, which is more common in women. Endothelial dysfunction — in which the lining of the artery doesn't expand (dilate) properly to boost blood flow during activity — increases the risk of coronary artery spasm and sudden death.

Women and some doctors don't recognize the symptoms of heart attack in women. "We often don't see women until significant heart damage has occurred," says Dr. Lerman. "Information from this study will hopefully encourage women to seek treatment early."

Get treatment

WISE study results suggest that the commonly used treatments for coronary artery disease — angioplasty and stenting — are not the best option for women with more diffuse plaques. Angioplasty and stenting treat distinct plaques formations through techniques that flatten the protruding plaques against the artery wall then reinforce the area with a mesh tube called a stent.

"Women who have microvascular disease need medications to control any underlying risk factors, such as high blood pressure, high cholesterol and glucose intolerance," says Dr. Hayes. "Regardless of what your angiogram test results tell you, or whether you are a man or a woman, if you have risk factors for heart disease, you need to be treated."

Some women may benefit from treatment to reduce their risk of heart disease even before menopause. "Women with abnormally low estrogen levels before menopause are at higher risk of developing microvascular disease," reports Dr. Hayes. This may have implications around recommendations for hormone replacement therapy for low estrogen levels that occur before menopause.

There's a lot you can do to reduce your risk of cardiovascular disease. As this study points out, you may not be able to rely on some of the standard treatments for serious cardiovascular disease, so your best approach is a proactive one. Take care of yourself — quit smoking, treat your depression, eat healthy, be physically active. These treatment methods don't require extensive testing or gender modification, and studies aren't likely to rebuke this sound advice.

Put it in perspective

"This is still just one study — a good one — but it's looking at a select group of women. These same factors have not been studied in men the same way, so we may find out later that some of these things aren't necessarily sex specific," says Dr. Hayes.

"We do hope this study will make doctors more cognizant that women who have risk factors for heart disease still need to be treated even if their angiogram results are clear," says Dr. Hayes. "For women, this study confirms that if you have symptoms, you need to have them evaluated by your doctor. However, the bottom line message stays the same. You don't need extensive testing to start taking care of yourself today."

Last Updated: 02/27/2006
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