Heart Disease Often Undiagnosed In Women, Study Finds

Main Category: Heart Disease
Also Included In: Women's Health / Gynecology
Article Date: 09 Feb 2006 - 0:00 PST

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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). Heart disease, which is the leading cause of death in the U.S., 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 tracked 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 blockages in an angiogram (Maugh, Los Angeles Times, 2/1).

Findings
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. The findings also 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 plaque formed in coronary microvascular syndrome can interfere with blood flow and damage the heart muscle, leading to ischemic heart disease. According to 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 likely would have blockages.
  


• More than half of the participants without obvious blockages had abnormalities that could cause ischemic heart disease.
  


• After four years, the rate of death or heart attacks among participants without obvious blockages was 10%, "much too high for somebody with a normal coronary angiogram," according to Pepine (Grady, New York Times, 2/1).

Recommendations, Comments
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). George Sopko, a project officer for WISE and a heart specialist at the National Heart, Lung and Blood Institute, 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).

Abstracts of the papers are available online.

Meida Coverage

ABCNews' "World News Tonight" on Tuesday reported on the study. The segment includes comments from Bairey Merz and Sharonne Hayes, director of the Mayo Clinic's Women's Heart Clinic (Pinto, "World News Tonight," ABCNews, 1/31). Video of the segment is available online.

NPR's "All Things Considered" on Wednesday included an interview with Bairey Merz about the study (Brand, "All Things Considered," NPR, 2/1). The complete segment is available online in RealPlayer.

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