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    Wednesday, February 01, 2006

    A Woman's Tender Heart: Heart disease may really be different in women:

    Even women whose coronary arteries are free of major blockages could be heading toward a heart attack, scientists cautioned Tuesday.

    Roughly 12 million U.S. women are thought to have heart disease, and as many as 3 million of them have a condition called coronary microvascular syndrome, the scientists write in a supplement to the Journal of the American College of Cardiology. In women with this condition, plaque has accumulated in the tiniest arteries of their heart, reducing oxygen flow.

    Standard X-rays of the coronary arteries, or angiography, miss the problem; only additional tests of coronary blood flow can tip doctors off.

    ....Men get coronary microvascular syndrome, too, but they represent only 20% of cases, says WISE chair C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

    So, let's see. In women, 25% of the cases are due to microvascular disease, compared to only 20% in men. Not such a striking difference after all. The lesson being that we should keep our eyes and minds open to the possibility in all of our patients whose symptoms are more suggestive of heart disease than their coronary angiogram would suggest. [as pointed out in the comments, it does appear that they mean 20% of the microvascular cases are men, not the otherway around. My mistake.-ed.]

    Unfortunately, disease of the very tiny vessels is not as amenable to an easy fix as disease of the large vessels. All you can do is reduce/eliminate as many risk factors as possible - stop smoking, watch the diet, control blood pressure - and take medication to try to keep the very little blood vessels as open as possible.

    posted by Sydney on 2/01/2006 08:35:00 AM 3 comments


    I think they mean only 20% of those with coronary microvascular syndrome (also called syndrome X) are men.

    By Anonymous Anonymous, at 1:19 PM  

    Frankly, this news report is sensationalism that does nobody any good.
    Consider the fact that the symptoms are atypical, and so unreliable in making the diagnosis. The physical exam is normal. The EKG is normal. The angiogram is normal. (Studies of coronary vasodilatory reserve are done only in research settings.) So essentially any woman who complains of any symptom may have the disease. Or may not have the disease.
    Thank you very much.

    By Anonymous Steve, MD, at 6:26 PM  

    Challenging Existing Paradigms in Ischemic Heart Disease: The NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE):
    7 February 2006; Vol. 47, No. 3_Suppl_S

    From one of the abstracts in JACC:
    "Moreover, the data further support the concept that the mechanism of ischemia in women may be localized in the microvascular coronary arteries. Therefore, the diagnoses of coronary microvascular dysfunction or endothelial dysfunction should be considered in women with chest pain who do not have obstructive coronary artery disease. It may be advantageous to add such diagnostic tests when the conventional tests are nondiagnostic. A revised clinical approach to cardiovascular disease in women may be designed and tested based on these findings."

    I do not find that this is sensationalism. I think it is a heads up to realize that just because women don't have obstructive CAD, does not mean that they can't be symptomatic or even DIE from their disease. The supplemental issue of JACC released today has many articles based on the WISE study. As the headline above indicates, paradigms may need to change.

    If we maintain an attitude such as steve, md, then many women will be dismissed as not having ischemia when in fact they do have IHD.

    By Anonymous CardioNP, at 7:51 PM  

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