"They are very important, but we don't typically look at them," Bairey Merz said. "This appears to be dominantly a women's problem."
That was the case with Laura Luxemberg, 40, of San Diego. Bairey Merz diagnosed her with "microvascular disease" after she was initially told that her shortness of breath, headaches, chest tightness and other symptoms might be a digestive problem.
"I was one of the lucky ones. I escaped an actual heart attack," said Kathy Kastan, 41, of her initially misdiagnosed heart disease.
(Troy Glasgow For The Washington Post)
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"That's what happened to my sister, too, three years ago. She went to the emergency room and was told to take Maalox," said Luxemberg, whose sister subsequently died from a heart attack.
One of the most disturbing implications is that many women would not be helped by the most aggressive treatments used to treat heart disease: surgery to bypass blocked major arteries and angioplasty, a procedure that wedges open clogged arteries and often keeps them open with tiny scaffolding called stents.
"If you don't have a discrete blockage, you have nothing to bypass. Sticking in a bypass may actually make things worse. You can't put a stent in the whole length of the vessel," said Sharonne N. Hayes, who runs a women's heart clinic at the Mayo Clinic in Rochester, Minn.
Women do respond to many of the drugs used to treat heart disease, including aspirin, cholesterol-lowering statins and vessel-dilating "ACE inhibitors," perhaps by reducing inflammation and improving blood vessel function. But doctors such as Hayes have also started using new combinations of these drugs, as well as other, alternative treatments such as an amino acid called L-arginine, specifically to reduce inflammation and keep arteries functioning properly.
But much more research is needed, experts say. Researchers are developing ultrasound and other imaging techniques to help diagnose women earlier, for example. Drugs that boost hemoglobin might help treat them.
"Basically," Legato said, "we're doing a whole different kind of research, looking at women instead of just looking at men, which is what we have been wont to do."
