Sept. 7, 2005 (Stockholm, Sweden) -- Doctors are beginning to understand what poets have long known: A woman's heart is a thing of mystery.
A new study shows that women who go to the hospital suffering from the crushing chest pain from coronary artery disease are three times more likely than men to be diagnosed as being free of heart disease. Yet within a year, they are almost three times more likely to be readmitted with even worse angina or a heart attack than men who were told they have "clean" heart arteries, says Karin Humphries, DSc, a heart specialist at St. Paul's Hospital in Vancouver, British Columbia.
"Women with angina who are told that an angiogram shows no disease should consider going to a cardiologist for a more thorough checkup," Humphries tells WebMD. "And at the first sign of chest pain, they should go back to the hospital -- immediately."
Coronary angiogram evaluates the heart vessels. During the procedure a thin, flexible tube is inserted into a blood vessel, usually in the groin, and guided toward the heart. A dye is injected into the blood vessel to make narrowed heart arteries more visible on an X-ray.
Though angiogram is a powerful diagnostic tool, it is limited in its ability to directly image the wall of the heart arteries, Humphries says. As a result, narrowed blood heart vessels caused by plaque may not be apparent; these abnormalities have the potential to cause heart attacks.
More rigorous heart imaging tests may reveal blocked arteries even when angiography is normal, she says.
Closing the Gender Gap
Other heart doctors who heard the findings at the annual meeting of the European Society of Cardiology here say that they are just beginning to realize the scope of the gender gap in heart health.
"For a long time we thought women were at lower risk [of heart attacks] than men," says Ian Graham, MD, a cardiologist at Adelaide and Meade Hospital in Dublin, Ireland.
"In truth women may actually have more severe atherosclerosis, even if they have apparently normal findings on an angiogram."
Caroline Daly, MD, of Royal Brompton Hospital in London, says part of the problem is medical school training. "The 'typical' heart is based on studies of men. We need to move away from the male paradigm," Daly tells WebMD.
The gender gap is beginning to close, Daly says, but more still needs to be done to improve heart care in women.
Older Age Doesn't Explain Women's Heart Risks
Humphries' team studied more than 32,000 men and women who came to the hospital suffering from chest pain and underwent coronary angiogram. Of those, 23% of the women and 7% of the men were found to have normal coronary arteries.
Over the next year, 26 women were rehospitalized with severe angina or a heart attack, compared with only six men.
"The increased risk in the women could not be explained by their older age or other health conditions," Humphries says.
Other Heart News
Among the other news released at the conference, whose theme is Women at Heart:
- A study of more than 110,000 men and women showed more people are surviving a first heart attack than a decade ago. But the gains in women are much smaller than in men: By five years after their heart attack, 39% of men and 53% of women had died.
- A European study of nearly 3,800 people with angina showed women are less likely to get standard treatment for heart disease, such as aspirin and cholesterol-lowering drugs.