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Anna K. Baer, MD
Albemarle Cardiology, PLC
Cardiovascular disease is the leading cause of death for American women.
More than 250,000 women die each year from ischemic heart disease.
Only 13% of women consider heart disease to be their greatest health risk.
38% of women who have an MI die within one year, compared with 25% in men.
Women are more likely to present with atypical symptoms.
Women are less likely to have obstructive coronary disease.
Stress testing may not be as accurate in women.
Women have worse outcomes after PCI and CABG.
Making the diagnosis of ischemic heart disease in women may be more challenging. Women are more likely to have microvascular disease and less likely to have obstructive coronary disease. Also, assessment of
traditional risk factors may not be as revealing in women. Women are more likely than men to have a false positive stress test. Treatment of women with suspected microvascular disease should include aggressive risk factor modification, including the use of statins, ACE inhibitors, and aspirin.
Another problem is that a traditional stress test may not be as diagnostic in a woman. An exercise ECG without imaging is limited to patients who have a normal resting ECG and patients who can exercise. The ECG diagnostic criteria for a positive test has lower diagnostic accuracy in women than in men. ECG changes during exercise have been reported to be of diminished accuracy in women as a result of more frequent resting ST-T wave changes, lower ECG voltage, and hormonal factors. Furthermore, women undergoing stress testing who achieve only low work levels (5 mets on the Bruce protocol) may go undiagnosed. Women also tend to have higher false positive rates. Both nuclear stress testing and stress echocardiography seem to be highly sensitive in both women and men.
To further complicate matters, women tend to be treated at later stages of their ischemic heart disease and be treated less aggressively. Women may delay seeking healthcare. They also tend to present with atypical symptoms, which may make a quick diagnosis more challenging. However, a delay in diagnosis may
contribute to worse outcomes in women. There are more male admissions every year for myocardial infarctions, but women have a higher one-year death rate and reinfarction rate than do men. After being treated, women have more problems with anxiety and depression than their male counterparts. They also have more problems with refractory chest pain.
Women are less likely to have obstructive coronary disease than their male counterparts. Thus, the traditional methods for diagnosing disease in women may not be as accurate. Women may be more prone to endothelial dysfunction and microvascular disease as the cause of their ischemia and chest pain. Accordingly, women get less symptom relief from revascularization procedures. Unfortunately, women with coronary artery disease have a worse prognosis than their male counterparts. Because women are less likely to have obstructive coronary disease, revascularization strategies are often less effective for these women.
Women are less likely to have obstructive coronary disease than their male counterparts. Thus, the traditional methods for diagnosing disease in women may not be as accurate. Women may be more prone to endothelial dysfunction and microvascular disease as the cause of their ischemia and chest pain. Accordingly, women get less symptom relief from revascularization procedures. Unfortunately, women with coronary artery disease have a worse prognosis than their male counterparts. Because women are less likely to have obstructive coronary disease, revascularization strategies are often less effective for these women.