His and Hers Heart Disease

Oct. 12, 2009 -- Women with heart disease may have worse outcomes than men do because treatment typically focuses on obstructive coronary artery disease -- which up to half of women may not have, according to a new review of the topic.

For many women, the problem is not obstruction in major heart blood vessels, but a reduction in blood flow, called ischemia, in very small arteries of the heart, says C. Noel Bairey Merz, MD, director of the Women's Heart Center at the Heart Institute at Cedars-Sinai Medical Center in Los Angeles. She is the lead author of a review published in the Journal of the American College of Cardiology. Bairey Merz and her colleagues reviewed numerous published studies about gender differences in heart disease before writing the review.

''Women, particularly at midlife, 45 to 65, are more likely to have abnormalities of the function of the small arteries -- you do not see those vessels on the traditional angiogram," Bairey Merz tells WebMD. "They are more likely to be falsely reassured when in fact there is a problem."

Bairey Merz and colleagues propose that the term coronary heart disease or CHD be used when the problem is obstructed major coronary vessels, but that the term ischemic heart disease or IHD be used when the problem is reduced blood flow because of small artery problems.

About 25% to 50% of women with heart disease don't fit the typical male CHD pattern and instead have ischemic heart disease, Bairey Merz estimates.

About 20 years ago, doctors and researchers began to suspect that women's heart disease is often different than men's, Bairey Merz says.

''This [review] is sort of a 'what do we know now, in 2009, going into 2010.' We have a story to tell that is starting to hang together.''

Bairey Merz is the chair for the National Institutes of Health Women's Ischemia Syndrome Evaluation (WISE) initiative. The WISE study was launched in 1996.

Heart Disease: Men vs. Women

After reviewing the published studies, Bairey Merz says, "It remains true that men and women differ, on average, in terms of symptom presentation. Men are more likely to have the Hollywood heart attack -- the chest pressure, chest pain, the typically exertional heart attack."

''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.