Test may miss Heart Disease in Women
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Test May Miss Heart Disease in Women
A February 1, 2006, Los Angeles Times article reported that angiography, the standard test for detecting heart disease, does not identify the disease in one out of six women who have it—causing physicians to send sick women home with a clean bill of health.
Although high cholesterol levels in men tend to lead to blockages that can be seen on an angiogram, the same conditions in women result in a general narrowing of the arteries that does not show up. The findings, the results of the Women’s Ischemia Syndrome Evaluation, appeared in a series of papers published in a supplement to the February 7 issue of the Journal of the American College of Cardiology.
The eight-year study followed 1,000 women in Florida, Pennsylvania and Alabama who had chest pains and other cardiovascular symptoms but whose angiograms showed no evidence of a blockage.
The study identified a new disorder, coronary microvascular syndrome, which accounts for 15% of all coronary artery disease in women, said C. Noel Bairey Merz, MD, who led the study. She said the reason the syndrome was detected in this study is that previous research has been conducted only in men.
Researchers found that half the women in the study were not getting enough blood to their hearts and that a third were likely to have a heart attack or some other serious problem—more than three times the normal risk.
In light of the study results, cardiologists should be more reluctant to dismiss the concerns of women with chest pains and no apparent blockages, and be more willing to order additional tests, said Elizabeth G. Nabel MD, director of the National Heart, Lung and Blood Institute, Bethesda, MD.
Microvascular syndrome can be detected with alternative techniques such as nuclear single-photon emission computed tomography (SPECT), which can identify about a third of patients with the condition. A more effective way is provocative coronary testing, a stress test in which an adenosine injection mimics the effects of exercising on a treadmill. According to Dr. Bairey Merz, this test is much more effective than the treadmill test itself.
Once the condition is detected, it can be treated with drugs such as beta blockers and ACE inhibitors to lower blood pressure, statins to lower cholesterol levels and the dietary supplement L-arginine. But because the recognition of the syndrome is so new, Dr. Bairey Merz added that research about effective treatments has yet to be done.
(Source: Los Angeles Times) |
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