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Heart Disease Undiagnosed in Many Women Because
Plaque Spreads
They mistakenly appear to have clear arteries after
angiography
Jan. 31, 2006 - In as many as 3 million U.S. women
with coronary heart disease, cholesterol plaque may not build up into
major blockages, but instead spreads evenly throughout the artery wall.
As a result, diagnostic coronary angiography reveals that these women
have clear arteries no blockages incorrectly indicating low risk.
Despite this, many of these women have a high risk for heart attack,
according to newly published research from the National Institutes of
Health.
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In women with this condition, called coronary
microvascular syndrome, plaque accumulates in very small arteries of the
heart, causing narrowing, reduced oxygen flow to the heart, and pain
that can be similar to that of people with blocked arteries, but the
plaque does not show up when physicians use standard tests.
As a result, many women go undiagnosed, according
to findings from the National Heart, Lung, and Blood Institutes (NHLBI)
Womens Ischemia Syndrome Evaluation (WISE) study. Insights from the
study are published in a special supplement to the February 6 issue of
the Journal of the American College of Cardiology, available online
January 31.
When a diagnosis of this condition is missed,
women are not treated for their angina and high cholesterol and they
remain at high risk for having a heart attack, said NHLBI Director
Elizabeth G. Nabel, M.D.
This study and the high prevalence of coronary
microvascular dysfunction demonstrate that we must think out of the box
when it comes to the evaluation and diagnosis of heart disease in
women.
The National Institutes of Health initiated WISE in
1996 to increase scientific knowledge about ischemic heart disease in
women. WISE aimed to develop accurate diagnostic approaches for ischemic
heart disease detection in women, to better understand the ways in which
heart disease develops in women including the significance of ischemia
without coronary blockages in women, and to evaluate the influence of
hormones, on ischemic heart disease development and diagnosis.
So much of our understanding of the underpinnings
of heart disease and heart attack, and the basis for our standard
methods of diagnosis and treatment are the result of research conducted
on men, said C. Noel Bairey Merz, Cedars-Sinai Medical Center and the
WISE study chairperson. Through clinical experience, many critical
questions arose about how the disease may manifest differently in women,
and how diagnostic techniques may need to be used differently in order
to prevent more heart attacks and save lives.
WISE investigators found that the majority of women
with clear angiography who are not diagnosed will continue to have
symptoms, a declining quality of life, and repeated hospitalizations and
tests.
Through WISE, we have made tremendous progress
toward better understanding of heart disease in women. Too often women
are tested again and again, go untreated, and still have high risk for
heart attacks, said George Sopko, MD, NHLBI project officer for WISE.
As clinicians we must systematically examine women for evidence of any
blockages and initiate intensive treatment for their risk factors.
Authors of six review papers providing insight on
WISE conclude that the study has provided the groundwork for additional
controlled clinical studies of diagnostic tools and treatments in women
with ischemic heart disease.
Additional study conclusions from WISE appear in
the same JACC edition:
● Identifying Candidates for Exercise Stress
Testing: Using the evaluative tool Duke Activity Status Index (DASI) in
women with heart disease symptoms prior to stress testing can help
determine who would be eligible for an exercise stress test versus a
stress test using intravenous medications to increase the heart load
instead of exercise. Current guidelines offer physicians little guidance
on how to identify women who would not be able to sufficiently complete
the exercise test. The DASI has been previously validated as a useful
tool for determining functional capacity.
● Low Coronary Flow and Scores on Function Test
Indicate Poor Outcomes: Women who have low DASI scores also have lower
coronary flow velocity, a combination which may explain the poor
outcomes seen for women with heart disease but no blocked arteries.
● Role of Pre-menopausal Hypertension in Disease
Risk: Women who have high blood pressure before menopause, especially
high systolic blood pressure, should be considered at a higher risk and
treated accordingly.
Resources:
● For information on women and heart disease, see
www.hearttruth.gov.
● For information on coronary microvascular
dysfunction,
click here.
NHLBI is part of the National Institutes of Health
(NIH), the Federal Governments primary agency for biomedical and
behavioral research. NIH is a component of the U.S. Department of Health
and Human Services. NHLBI press releases and other materials including
information about women and heart disease are available online at
www.nhlbi.nih.gov.
The National Institutes of Health (NIH) The
Nation's Medical Research Agency includes 27 Institutes and Centers
and is a component of the U. S. Department of Health and Human Services.
It is the primary Federal agency for conducting and supporting basic,
clinical, and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
http://www.nih.gov.
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