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    His and Hers Heart Disease

    Up to Half of Women May Not Have ‘Traditional’ Heart Disease, Experts Say

    Heart Disease: Men vs. Women continued...

    ''Women are less likely to have that Hollywood-type heart attack pain. They are less likely to describe it as pain. It might be pressure, but they are more likely to have indigestion and shortness of breath.''

    Another difference is that women tend to have more problems in the small arteries of the heart, she says.

    In the cardiac catheterization lab, when doctors check the blood flow in the coronary arteries, women's arteries are often open, whereas men's are often obstructed, she says. "Men are much more likely to have fatty buildup of the large arteries," she says.

    As a result, treatment strategies aren't optimized for women, Bairey Merz says, because they often don't fit the mold.

    ''The focus should be on ischemia and ischemic heart disease, particularly for women, and that women are not adequately served when we don't focus on that, when we just focus on the anatomy, the obstruction of [major heart] blood vessels."

    Among other points discussed in the review:

    • More women than men die annually in the U.S. from heart disease -- 455,000 women compared to 410,000 men.
    • Women are more likely than men to die from a heart attack and are more frequently hospitalized for heart failure.
    • Women have higher average levels of C-reactive protein, a marker of inflammation and predictor of heart disease.
    • The Framingham Risk Score, a traditional measure of heart disease risk, classifies more than 90% of women as low risk. A newer tool, the Reynolds Risk Score, may work better for women.

    Second Opinion

    ''It's a really important review,'' says Nieca Goldberg, MD a cardiologist and spokeswoman for the American Heart Association, who is also director of the New York University Langone Medical Center Women's Heart Center and clinical associate professor of medicine at NYU.

    "It's been a long time since someone has put together all the smaller studies in one place for doctors to get all the information," says Goldberg, who reviewed the study for WebMD and has written several books on women's heart health.

    For women with heart disease symptoms, she says: "Just because your angiogram is normal doesn't mean you aren't having ischemic symptoms."

    ''If you think you have been misdiagnosed, seek a second opinion," Bairey Merz tells women who suspect they have heart disease.

    ''There are increasing numbers of medical centers that have women's heart programs," she says.

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