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Gender-Specific Research Improves Accuracy of Heart Disease Diagnosis in Women

Male model of heart disease doesn’t apply to women

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 (CAD) as contributors to ischemic heart disease (IHD) in women, according to a new statement published in the American Heart Association journal Circulation.

“For decades, doctors used the male model of coronary heart disease testing to identify the disease in women, automatically focusing on the detection of obstructive coronary artery disease,” said lead author Jennifer H. Mieres, MD. “As a result, symptomatic women who did not have classic obstructive coronary disease were not diagnosed with ischemic heart disease and did not receive appropriate treatment, thereby increasing their risk for heart attack.”

In the past, there was a lack of recognition of the importance of non-obstructive CAD in women, leading to diagnoses of “false positive” stress tests and a lack of appropriate treatment, Mieres said. However, new research indicates that women with non-obstructive CAD and abnormal stress tests in fact have an elevated risk of heart attack.

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

The new statement is intended for women who have symptoms of IHD, including the classic symptoms of left-sided chest pain and pressure, jaw pain, upper back pain, widespread “indigestion,” and other symptoms not localized to the chest.

Recommendation highlights include the following:

  • Women with suspected IHD should discuss the benefits and risks of diagnostic tests with their health care provider. For example, a woman of child-bearing age may want to avoid tests that require exposure to radiation.
  • Health care professionals should consider whether a woman is at low, intermediate, or high risk for IHD when determining the appropriate diagnostic tests for their patients. The risk level is based partly on age combined with risk factors, such as diabetes and hypertension.
  • Health care professionals, for the first time, should consider a woman’s functional ability — i.e., 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 electrocardiogram; and symptomatic women with warning signs, including functional disability, might be candidates for cardiac magnetic resonance imaging or cardiac angiography.

“This new and better understanding of women and ischemic heart disease arms clinicians with the knowledge and tools needed to accurately determine risk and treatment strategies for the disease in symptomatic women who were previously undiagnosed,” Mieres said.

Source: AHA; June 16, 2014.

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