Anxiety in women may mask heart disease symptoms, researchers say
In women who had never been diagnosed with heart disease, researchers found that those with anxiety were 75 percent more likely than women without anxiety to have reduced blood flow to the heart during activity.
Study author Kim Lavoie says the findings may indicate that anxiety symptoms such as chest discomfort or palpitations—which can overlap those of heart disease—may mask heart disease in women. This could lead to misdiagnosis, she said.
"If you're a woman and you say you're tired, short of breath, and really anxious about it, and you have no pre-existing heart disease, it's possible that doctors are confounding the two problems," said Lavoie, a professor of psychology at University of Quebec at Montreal and director of the Chronic Disease Research Division at Hopital du Sacre-Coeur de Montreal in Canada.
"Doctors may be more likely to attribute those symptoms to anxiety than heart disease," she added. "So, in other words, a diagnostic bias may occur."
The study was published online Feb. 23 in the journal Circulation: Cardiovascular Quality and Outcomes.
In the study, the researchers said anxiety disorders appear to be more common in women than in men, and there is a link between these disorders and worse cardiac outcomes.
Heart disease kills about the same number of women as men in the United States every year and is the leading cause of death in American women, causing one in every four female deaths, according to the U.S. Centers for Disease Control and Prevention.
Women can experience different symptoms from men during a heart attack. For example, women are more likely to describe chest pain that is sharp or burning and more frequently have pain in the neck, jaw, throat, abdomen or back, the CDC says.
When a mood or anxiety disorder is added into the mix, a woman's true health status can be misinterpreted, Lavoie's research suggested.
For the study, the researchers looked at more than 2,300 patients, including 760 women, who underwent an exercise stress test and a psychiatric interview.
The exercise stress test looked for reduced blood flow (ischemia), which can cause a shortage of oxygen to the heart, and the effects of gender and mood/anxiety on this condition.
Lavoie and her team found that women with anxiety were far more likely to show ischemia than women without anxiety. They found no similar effects in men.
Dr. Karla Kurrelmeyer, a cardiologist at Houston Methodist DeBakey Heart and Vascular Center in Texas, said physicians have been working for years to decipher the link between anxiety and heart disease, "because we realize there's a connection between being distraught or anxious and it affecting the nervous system."
Kurrelmeyer agreed with Lavoie that the women with anxiety who exhibited reduced blood flow to the heart might actually have had heart disease that previously went undiagnosed.
"Women with anxiety should be treated seriously because frequently they have ischemia . . . and doctors need to do more diagnostic testing to make sure symptoms are due to anxiety instead of obstructive coronary artery disease," said Kurrelmeyer, who wasn't involved in the new research.
Lavoie said women with anxiety or depression who are concerned about heart disease can ask their doctor to order tests to check their heart health.
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