Advances Help Diagnose Women’s Heart Disease

Heart disease identification and treatment in women improves with gender specific research

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) While heart disease affects both sexes, testing for it originally developed according to symptoms in men. Research has now recognized gender differences that may help prevent and treat the condition.

Although many may continue to think of heart disease as a man’s health issue, women account for just over half of the total heart disease deaths in the US each year, according to The Heart Foundation. In recent decades, researchers have recognized that coronary heart disease can present itself differently in women. A new scientific statement from the American Heart Association (AHA) reviews heart disease symptoms unique to women and provides recommendations for diagnosis and care.

"Be aware of heart disease symptoms and risks unique to women."

Jennifer H. Mieres, MD, professor of Cardiology, Population Health, R Hofstra North Shore-LIJ School of Medicine in Hempstead, New York, and collaborators wrote an AHA consensus statement underscoring the role of non-invasive testing to evaluate women suspected of having ischemic heart disease.

Ischemic heart disease, or coronary artery disease (CAD), is a narrowing of the arteries that supply blood to the heart muscle. It is generally caused by the buildup of plaques in blood vessel walls in a process called atherosclerosis. A decreased flow of oxygen-rich blood to the heart muscle can lead to heart attack and a reduced function in the heart to pump blood.

In the statement, authors highlighted how recent studies focusing on heart disease in women have helped understand differences in how obstructive and non-obstructive CAD affect women.

While obstructive is a definite block of blood flow from plaque buildup, non-obstructive is the result of damage to small arteries or the inner lining of the main arteries leading to the heart. This weakening of the arteries can lead them to spasm and inhibit blood flow.

Some women with non-obstructive heart disease, or coronary microvascular disease, will also have obstructive CAD.

In the past, non-obstructive CAD was often diagnosed as non-specific chest pain and thought to be benign. Today, women identified as having non-obstructive CAD and abnormal stress test results are recognized as having a higher risk for heart attack.

“For decades, doctors used the male model of coronary heart disease testing to identify the disease in women, automatically focusing on the detection of obstructive coronary artery disease,” said Dr. Mieres in a press release. “As a result, symptomatic women who did not have classic obstructive coronary disease were not diagnosed with ischemic heart disease, and did not receive appropriate treatment, thereby increasing their risk for heart attack.”

While the most common presentation of ischemic CAD is chest pain or discomfort, women may have a different pattern of non–chest-related pain symptoms. Non-chest pain symptoms may include fatigue, weakness, shortness of breath, dizziness, pain or discomfort in jaw, neck arms or stomach, and upper back pressure.

Compared with men, women’s symptoms are more likely to result from mental or emotional stress than from physical exertion.

The authors suggest that women with at possible risk of CAD discuss positives and negatives (such as radiation exposure) of diagnostic tests. They also recommend that women decide on testing based on their risk level, which may be determined by factors such as age, blood pressure and diabetes status.

Those at the lowest risk level should not undergo diagnostic testing, according to investigators, but women with slightly elevated risk might have a treadmill exercise electrocardiogram (EKG).

Dr. Mieres and her collaborators write that cardiac MRI (magnetic resonance imaging) or cardiac CT angiography (computed tomography that looks at the heart) might be appropriate for those showing more definite signs of CAD, such as functional disability. When women are less able to carry out the functions of everyday life, they are considered at a higher risk of heart attack.

"This new and better understanding of women and ischemic heart disease arms clinicians with the knowledge and tools needed to accurately detect, determine risk and treatment strategies for the disease in symptomatic women who were previously un-diagnosed," Dr. Mieres said in a press release.

The statement was published June 16 in the American Heart Association journal Circulation.

Review Date: 
June 16, 2014
Last Updated:
June 17, 2014