A Gender Difference In Heart Disease

By Rob Stein
Washington Post Staff Writer
Wednesday, February 1, 2006

Many women suffer from a form of heart disease that is fundamentally different from the type that strikes most men and is easily missed by standard tests, researchers reported yesterday.

Instead of developing obvious blockages in the arteries supplying blood to the heart, these women accumulate plaque more evenly inside the major arteries and in smaller blood vessels, the researchers found. In other cases, their arteries fail to expand properly or go into spasm, often at times of physical or emotional stress.

These abnormalities, which appear to be particularly common in younger women, can be as dangerous as the better-known form of the disease, strangling vital blood flow to the heart muscle, causing severe and sometimes debilitating pain and fatigue, and sometimes triggering life-threatening heart attacks, the researchers found.

The findings may help explain why some women suddenly have heart attacks even though their arteries look clear, in some cases leading doctors to send them home without treatment or refer them to psychiatrists. Their symptoms are often unusual: Instead of the classic crushing chest pain, sweating and shortness of breath, they often complain of vague symptoms -- fatigue, an upset stomach, or pain in the jaw or shoulders.

Even when they do get medical attention, these women may not benefit from standard drugs and therapies, such as bypass surgery and angioplasty to reopen clogged arteries, the researchers said.

As many as 3 million U.S. women may suffer from the condition, they said.

"We're realizing that this may be fairly common among women," said George Sopko of the National Heart, Lung and Blood Institute, which is funding the research. "This is a big deal. This is changing our thinking about heart disease in many women."

Researchers have long known that women with heart disease -- the nation's leading killer -- tend to be diagnosed later and fare more poorly. The usual explanation has been that women do not seek treatment as early as men and doctors do not treat them as aggressively. But some researchers suspected the disease may also manifest itself differently, so the National Institutes of Health launched the Women's Ischemia Syndrome Evaluation (WISE) to find out. It has been tracking about 1,000 women since 1996 who have pain or other symptoms but who mostly seem fine on standard tests.

Researchers have been reporting partial results slowly for years. But in the hope of stimulating a fundamental reassessment of heart disease in women, they have for the first time collected their findings in a comprehensive set of papers, to be published with the latest data in the Feb. 7 issue of Journal of the American College of Cardiology.

"We're trying to paint an overall picture that really questions the dominant paradigm," said C. Noel Bairey Merz of the Cedars-Sinai Medical Center in Los Angles, who leads the WISE study. "What we're saying is that in many cases heart disease is a fundamentally different disease in many women in ways that we need to pay attention to."

The studies were released yesterday, the same day the American Heart Association's journal, Circulation, published another set of papers about heart disease in women.

The WISE study showed that many women whose arteries looked clear in angiograms and other standard tests had a significantly elevated risk of having a heart attack or dying within four or five years.

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