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Even women whose coronary arteries are free of major blockages could be heading toward a heart attack, scientists cautioned Tuesday.
Roughly 12 million U.S. women are thought to have heart disease, and as many as 3 million of them have a condition called coronary microvascular syndrome, the scientists write in a supplement to the Journal of the American College of Cardiology. In women with this condition, plaque has accumulated in the tiniest arteries of their heart, reducing oxygen flow.
Standard X-rays of the coronary arteries, or angiography, miss the problem; only additional tests of coronary blood flow can tip doctors off.
Women with this condition might seek medical care because they're unable to perform their normal daily activities. They complain of low energy and shortness of breath, but not necessarily the chest pain experienced by men with coronary artery disease.
In the past, doctors would often attribute such symptoms to neuroticism or depression, especially when angiography revealed nothing unusual, says George Sopko of the National Heart, Lung, and Blood Institute, who serves as the project officer for the ongoing WISE study, the journal supplement's focus.
WISE, short for Women's Ischemia Syndrome Evaluation, began following 1,000 women in 1996. Its goal is to improve the diagnosis of heart disease in women and better understand its development. To enroll in the study, women had to have been referred by their doctor for an angiogram because of suspected or documented heart disease.
The key message of the WISE journal supplement, says Sopko: "If you've got symptoms, don't sit on them. Go ahead and have them checked out."
Men get coronary microvascular syndrome, too, but they represent only 20% of cases, says WISE chair C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles. In the USA, more women than men have died of heart disease every year since 1984. Yet, most studies about the diagnosis and treatment of heart disease have been conducted in men, she says.
On average, WISE has followed participants for about five years, Bairey Merz says. Other research has found that many women with small-vessel heart disease go on to develop large blockages over the course of a decade, she says.
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