Heart disease in women not being detected- Testing!

Discussion in 'Fibromyalgia Main Forum' started by darude, Feb 1, 2006.

  1. darude

    darude New Member

    Heart disease in women not being detected
    No. 1 killer attacks females differently

    By Judy Peres
    Tribune staff reporter
    Published February 1, 2006


    Up to 3 million U.S. women are at higher risk of heart attack because they have coronary disease that does not show up on standard tests, the National Institutes of Health reported Tuesday.

    These women don't have significant blockages in major arteries. Instead, cholesterol plaque is spread evenly throughout the cells lining the arteries or accumulates in the tiny vessels branching within the heart itself.

    Women with the condition, called coronary microvascular syndrome, can experience pain similar to that felt by people with blocked arteries. But their plaque buildup does not show up on angiograms, the gold-standard test for diagnosing cardiovascular risk.

    As a result, women who complain of the symptoms and seek testing often are classified incorrectly as being at low risk of heart attack and sent home without treatment.

    The new findings may help explain why cardiovascular disease--often thought of as a "man's disease"--actually kills about 60,000 more women than men each year in the U.S., according to the researchers, whose work appears in the Journal of the American College of Cardiology.

    "When a diagnosis of this condition is missed, women are not treated for their angina [chest pain] and high cholesterol, and they remain at high risk for having a heart attack," said Dr. Elizabeth Nabel, director of the National Heart, Lung, and Blood Institute, an agency of the NIH. "We must think outside the box when it comes to the evaluation and diagnosis of heart disease in women."

    Heart disease is the leading cause of death in the U.S., the researchers note. It also kills far more women than breast cancer, a fact that may surprise some women who fear a tumor more than a heart attack.

    The heart institute started a study in 1996 to increase scientific knowledge about women and ischemic heart disease--a reduction of blood flow to the heart that can lead to heart attacks. One of its aims was to develop more accurate approaches for detecting the disease in women, who often have different symptoms than men.

    "So much of our understanding of the underpinnings of heart disease and heart attack, and the basis for our standard methods of diagnosis and treatment, are the result of research conducted on men," said Dr. C. Noel Bairey Merz of Cedars-Sinai Medical Center in Los Angeles. "Diagnostic techniques may need to be used differently [in women] in order to prevent more heart attacks and save lives."

    Bairey Merz chairs the study, called WISE for Women's Ischemia Syndrome Evaluation, which is following nearly 1,000 women with symptoms of ischemia.

    According to the findings reported Tuesday, the majority of women with "clear" angiograms who are not diagnosed will continue to have symptoms and a declining quality of life.

    "They are at higher risk of having a heart attack, being hospitalized or dying down the road," said Dr. George Sopko, project director for the study. "We must systematically examine women for evidence of any blockages and initiate intensive treatment for their risk factors."

    Among the study's findings:

    - Women with suspicious symptoms should be given a test of functional capacity, such as the Duke Activity Status Index. The 12-item questionnaire indicates whether a patient has difficulty with everyday activities, such as walking a block or two, and is a good indicator of cardiac prognosis.

    - Treadmill stress tests are not suitable for many women. Among other problems, the tests fail to identify about 40 percent of women with ischemia. Doctors, therefore, should consider using more sophisticated stress tests or those that induce stress chemically, which tend to be more accurate in women.

    - Women who have high blood pressure before menopause and overweight women of any age should be considered at higher risk for heart problems and treated accordingly.

    Experts said doctors may need to develop additional diagnostic tests for women. Among options being evaluated are testing for a protein associated with inflammation, checking for narrowing of the retinal arteries and scanning heart vessels for calcium deposits.

    Dr. Matthew Sorrentino, a cardiologist at the University of Chicago Hospitals, said the WISE data could be very useful in determining who is at higher risk, although the additional diagnostic tests the researchers mentioned are still experimental.

    He added that the WISE study clearly points up the need for additional research.

    "There has been a definite decline in fatal heart disease in men, but not in women," said Sorrentino. "We're not picking it up as well in women, and we're not reducing their rate of cardiac events. So let's do more advanced studies."The WISE researchers say symptoms of ischemia often are different in women and men.

    Women's pain may be in the arm or shoulder instead of the chest, it often does not radiate to the neck and they may not have heart palpitations. Women also are more likely to have non-specific symptoms, such as fatigue, sleep disturbance and shortness of breath.

    The WISE researchers recommended that patients and clinicians become more aware and aggressive in investigating these early complaints.

    "If you have [a patient with] symptoms and evidence of ischemia, even if the angiogram doesn't show significant blockage, you don't send her home. You treat her as a patient at higher risk," said Sopko.

    "You need to sit down and look at her profile and develop a long-term strategy. She needs to get active, quit smoking, lose weight, optimize her lipids [cholesterol] and blood pressure--whatever her risk factors are."

    But Sopko said additional research is needed to determine whether all such patients need to be on cholesterol-lowering drugs, such as statins.

    "We're not yet ready to change the treatment guidelines," he said. "But at least now we can tell her what the problem is, even if we don't yet have the best therapies."

    - - -

    What is your heart risk?

    The Duke Activity Status Index helps measure a woman's risk of heart disease: The lower the score, the higher the risk.

    Can you . . . / Points / Add the points if you can answer, "Yes, with no difficulty."

    1. Take care or yourself, that is, eating, dressing, bathing and using the toilet? 0.8

    2. Walk indoors, such as around your house? 0.5

    3. Walk a block or two on level ground? 0.8

    4. Climb a flight of stairs or walk up a hill? 1.6

    5. Run a short distance? 2.3

    6. Do light work around the house like dusting or washing dishes? 0.8

    7. Do moderate work around the house like vacuuming, sweeping floors, carrying in groceries? 1.0

    8. Do heavy work around the house like scrubbing floors or lifting or moving heavy furniture? 2.3

    9. Do yard work like raking leaves, weeding or pushing a power mower? 1.3

    10. Have sexual relations? 1.5

    11. Participate in moderate recreational activities like golf, bowling, dancing, doubles tennis or throwing a baseball or football? 1.7

    12. Participate in strenuous sports like swimming, singles tennis, football, basketball or skiing? 2.1

    TOTAL Scores of 4.7 or lower are considered higher risk

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  2. darude

    darude New Member

  3. lease79

    lease79 New Member

    Very interesting article :)
  4. darude

    darude New Member

    Please read