Gender-specific research improves accuracy of heart disease diagnosis in women

June 16, 2014, American Heart Association

Diagnosing coronary heart disease in women has become more accurate through gender-specific research that clarifies the role of both obstructive and non-obstructive coronary artery disease as contributors to ischemic heart disease in women, according to a new statement published in the American Heart Association journal Circulation.

"For decades, doctors used the male model of testing to identify the disease in , automatically focusing on the detection of obstructive coronary artery disease," said Jennifer H. Mieres, M.D., lead author of the statement and professor of Cardiology & Population Health, R Hofsrta North Shore-LIJ School of Medicine in Hempstead, New York.

"As a result, symptomatic women who did not have classic obstructive coronary disease were not diagnosed with , and did not receive appropriate treatment, thereby increasing their risk for heart attack."

Ischemic heart disease, also known as coronary heart disease, occurs because of a decreased blood flow to the heart muscle, most often due to coronary atherosclerosis from the buildup of plaque in the coronary arteries. This plaque can result in obstructions in the arteries, which diminishes blood flow to the heart muscle, reduces the heart's oxygen supply, and damages the heart muscle – resulting in heart attack and a decrease in the heart's pumping ability.

Non-obstructive coronary artery disease and coronary microvascular disease, which is more common in women, occur because of damage to small arteries or the inner lining of the main arteries leading to the heart, which can cause them to spasm, blocking blood flow. Some women may have both coronary microvascular disease and plaque build-up in the small arteries,

In the past, there was a lack of recognition of the importance of non-obstructive coronary disease in women, leading to diagnoses of "false positive" stress tests and a lack of appropriate treatment. However, new research indicates that women with non-obstructive and abnormal stress tests are in fact at an elevated risk of heart attack.

Women also experience a broader range of ischemic heart disease symptoms than men, and have a different pattern and distribution of pain symptoms, often not located in the chest. Additionally, women's symptoms are frequently associated with mental or emotional stress, and are less likely to result from physical exertion compared to men.

The statement is intended for women who have the symptoms of ischemic heart disease, including the classic symptoms of left sided chest pain/pressure, jaw pain, upper back pain, widespread "indigestion," and other symptoms not localized to the chest.

Recommendation highlights include:

  • Women with suspected ischemic heart disease should discuss the benefits and risks of diagnostic tests with their healthcare provider – for example, a woman of child-bearing age may want to avoid tests that require exposure to radiation.
  • Healthcare professionals should consider whether a woman is at low, intermediate, or high risk for ischemic heart disease when determining the appropriate diagnostic tests for their patients. Risk level is based partly on age combined with risk factors, such as diabetes and high blood pressure.
  • Health care professionals, for the first time, should consider a woman's functional ability – her ability to carry out the activities of daily living to determine the type of diagnostic testing needed. Women with low functional disability are now considered at increased risk for heart attack.
  • Women with the lowest risk should not undergo diagnostic testing; women at slightly higher risk should first undergo a treadmill exercise ECG (electrocardiogram); and symptomatic women with warning signs, including functional disability, might be candidates for cardiac MRI (magnetic resonance imaging) or cardiac CT angiography (computed tomography that looks at the heart).

"This new and better understanding of women and ischemic 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.," Mieres said.

Explore further: Heart disease without coronary plaque buildup linked to heart attack risk

Related Stories

Heart disease without coronary plaque buildup linked to heart attack risk

June 4, 2014
Non-obstructive coronary artery disease was associated with a 28 to 44 percent increased risk of a major adverse cardiac event such as a heart attack or death, in a new study presented at the American Heart Association's ...

Study: Response to emotional stress may be linked to some women's heart artery dysfunction

March 13, 2014
Researchers at the Barbra Streisand Women's Heart Center at the Cedars-Sinai Heart Institute have found that emotional stressors – such as those provoking anger – may cause changes in the nervous system that controls ...

Calcium score predicts future heart disease among adults with little or no risk factors

April 15, 2014
With growing evidence that a measurement of the buildup of calcium in coronary arteries can predict heart disease risk, Los Angeles Biomedical Research Institute (LA BioMed) researchers found that the process of "calcium ...

Younger Hispanic women face higher risk of death from heart attack

November 19, 2013
Younger Hispanic women face a higher risk of death in hospitals after a heart attack, are more likely to suffer from co-existing conditions such as diabetes, and are less likely to undergo percutaneous coronary interventions ...

International study finds heart disease similar in men and women

December 3, 2013
An analysis of data from an international multicenter study of coronary computed tomography angiography (CCTA) reveals that men and women with mild coronary artery disease and similar cardiovascular risk profiles share similar ...

PET/MR is superior for verifying coronary arterial disease

June 9, 2014
Ischemic heart disease, a narrowing of the arteries supplying blood to the heart, is a leading cause of death throughout the world. A hybrid molecular imaging technique called positron emission tomography and magnetic resonance ...

Recommended for you

Researchers borrow from AIDS playbook to tackle rheumatic heart disease

January 22, 2018
Billions of US taxpayer dollars have been invested in Africa over the past 15 years to improve care for millions suffering from the HIV/AIDS epidemic; yet health systems on the continent continue to struggle. What if the ...

A nanoparticle inhalant for treating heart disease

January 18, 2018
A team of researchers from Italy and Germany has developed a nanoparticle inhalant for treating people suffering from heart disease. In their paper published in the journal Science Translational Medicine, the group describes ...

Starting periods before age of 12 linked to heightened risk of heart disease and stroke

January 15, 2018
Starting periods early—before the age of 12—is linked to a heightened risk of heart disease and stroke in later life, suggests an analysis of data from the UK Biobank study, published online in the journal Heart.

'Decorated' stem cells could offer targeted heart repair

January 10, 2018
Although cardiac stem cell therapy is a promising treatment for heart attack patients, directing the cells to the site of an injury - and getting them to stay there - remains challenging. In a new pilot study using an animal ...

Two simple tests could help to pinpoint cause of stroke

January 10, 2018
Detecting the cause of the deadliest form of stroke could be improved by a simple blood test added alongside a routine brain scan, research suggests.

Exercise is good for the heart, high blood pressure is bad—researchers find out why

January 10, 2018
When the heart is put under stress during exercise, it is considered healthy. Yet stress due to high blood pressure is bad for the heart. Why? And is this always the case? Researchers of the German Centre for Cardiovascular ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.