Because plaque tends to collect in smaller blood vessels in women rather than in major arteries as it does in men, standard diagnostic testing of women can miss the warning signs of heart disease, a large US government study suggests.

Standard Tests May Not Work For Women

As many as 3 million women in the US have coronary microvascular syndrome, a condition in which small blood vessels are blocked by plaque, putting them at an increased risk of heart attack and even death, experts say.

Unfortunately, routine angiographies usually find only significant blockages in major arteries, according to results from the Women's Ischemia Syndrome Evaluation (WISE) study, initiated in 1996 and sponsored by the National Institutes of Health.

"We're learning more and more about women [and heart disease] every day. This is a mechanism of heart disease that frequently goes undiagnosed," says Dr. Nieca Goldberg, former chief of women's cardiac care at Lenox Hill Hospital in New .lork City and author of The Women's Healthy Heart Program.

Women and physicians should pay attention to symptoms related to the heart," adds Dr. George Sopko, WISE project officer for the National Heart, Lung, and Blood Institute (NHLBI).

The Numbers

Despite an awareness of the increasing number of women who have heart disease, coronary angiography-an X-ray examination of the blood vessels and chambers of the heart-is not specific enough to detect these problems in women, the researchers say.

WISE investigators found that a majority of women who were given an "all-clear" on their angiograms continued to have symptoms in addition to hospitalizations and a declining quality of life.

"We found that women who have no significant blockages but have evidence of ischemia are at a high risk for future heart attacks, repeat hospitalization or even death," says Sopko. "That was noted in small studies before but nobody had such a big [study group]."

Don't Ignore Symptoms

"When women go for an angiogram and they don't find blockages, it doesn't mean they don't have a problem. It means the problem isn't caused by a build-up of plaque," Goldberg says. "It doesn't mean that the symptoms aren't coming from the heart. They can come from very small blood vessels that we don't see in standard testing."

If women have symptoms, but no significant blockages, Sopko says you can't ignore the problem. "We're saying if you don't have the big blockages but you've got some problems, let's go look," Sopko says. "You don't neglect or deny medical therapy to these women."

An added problem, however, is that there aren't many ways to detect these kinds of problems, Goldberg says.

"Unfortunately, for this particular mechanism we don't yet have all the tools we need," Goldberg notes. "Clearly, when it comes to women and heart disease, we can't take for granted that it's going to be exactly the same script as for men."

Ischemic heart disease (IHD) is the leading cause of death in the United States, and women bear a disproportionate burden of the illness. Approximately 250,000 women die each year from IHD and its related conditions, according to the report. More than two-thirds (38%) of all deaths in women are related to coronary heart disease. And, since 1984, more women than men have died each year from IHD. It is the leading killer of women of all ages, the report adds.

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