A Gender Difference In Heart Disease
Variant in Women Called Hard to Detect

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.

When the researchers used ultrasound and other more sophisticated techniques to examine their arteries, they found that many actually had abnormalities. The women also tended to score higher on certain tests, such as those measuring levels of inflammation.

The researchers emphasized that many women do have the same kind of heart disease that afflicts men, and they benefit from the same preventive measures and treatments that help men -- a healthy diet and weight, regular exercise, and lowering blood pressure and cholesterol levels. But the WISE findings could help explain some of the disparities between the sexes and should alert both women and their doctors to the alternative manifestations of the disease, they said.

Although the researchers remain uncertain why women are prone to this form of the disease, it could be that hormonal or genetic differences change how their arteries react.

The study has also begun to identify new ways to identify women with the condition. A relatively simple questionnaire that gauges their ability to perform daily activities, for example, appears highly useful for identifying women with the condition who are at risk for suffering a heart attack or death, the researchers reported.

While it remains unclear how best to treat the condition, research suggests that certain drugs, such as those that reduce inflammation, may be useful.

Other researchers said the findings potentially fill an important gap in understanding a major health problem.

"I think this could help save a lot of lives," said Sharonne N. Hayes of the Mayo Clinic in Rochester, Minn. "This could help lead to better ways to diagnose and treat heart disease in women."

But some cautioned that the findings raised more questions than they answered and said much more research is needed.

"We need to be careful about research comparing women to men that involved only women," said Lori Mosca of Columbia University. "This could be very important to understanding heart disease in women, but we need to do more research that involves both men and women."

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