The study, presented at the American College of Cardiology conference held March 28 to 30, 2020, looked at a subgroup of women and men from the ISCHEMIA trial who received abnormal stress test results, an indicator of ischemia, a condition in which blood flow is restricted or reduced in a part of the body. Because women were more than three times as likely as men to have non-obstructive disease, or less artery narrowing (34 percent versus 11 percent), women composed only 23 percent of study participants, with about 1,100 women and 4,000 men ultimately included in the study. Despite having less-extensive disease than men, women had a 38 percent higher chance of having more chest pain. Results were the same even after other factors were considered, such as age, race, stress test results, medication use, smoking, diabetes, high blood pressure, previous heart attack, and kidney and heart function. “Even when women have very abnormal stress tests — more characteristic of what we think of as typical ‘male type’ coronary heart disease — they have less-extensive atherosclerosis and yet they are still having more symptoms as compared to men,” said Harmony Reynolds, MD, the director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health and the study’s lead author, in a press release. “It is possible that women have a better capability of sensing that the heart muscle isn’t getting enough blood flow than men do,” Dr. Reynolds told Everyday Health. “That difference has something to do with the way the nerves are wired in different parts of our bodies, and the difference in angina between women and men may similarly relate to nervous-system wiring.” Chest pain can interfere with a person’s ability to work or carry out daily activities. Martha Gulati, MD, the division chief of cardiology for the University of Arizona College of Medicine in Phoenix, who was not involved with the study, points out that we’re only at the early stages of understanding the cardiovascular differences between men and women. “In the past, if a woman came in with chest pain but had no narrowing of the arteries, she would be told there’s nothing wrong, but that’s not necessarily the case,” Dr. Gulati says. “Further testing should be done, or the patient should be sent to a doctor who specializes in women with heart conditions, because there might be better methods of treatment.” RELATED: Everything You Need to Know About Atherosclerosis
More Research on Women Will Lead to Better Treatment
Angina occurs when one or more arteries fails to deliver enough blood to a part of the heart that needs oxygen. Though the pain often goes away with rest, angina is usually a warning sign of heart disease, the leading cause of death for women in the United States. While angina often stems from plaque buildup in the heart’s main arteries, that’s not always the case. Angina can also be caused by microvascular disease, which affects the tiny blood vessels of the heart and makes it difficult for blood to flow efficiently to the heart muscle. Angina can look different in men and women. According to the American Heart Association, women experience a sharper form of chest pain that may be less severe than what men feel. Women may also experience shortness of breath, nausea, vomiting, and abdominal pain. “Now that we’re enrolling more women in these types of trials, we’re seeing that there is something going on in how the disease presents in women,” Gulati says. “But we need more trials and further study to figure out how to treat these types of patients.”
