Heart Disease In Women Often Missed

Women survive heart disease just as well as men if they get equivalent treatment, but all too often doctors fail to diagnose heart disease in female patients, researchers reported Tuesday at the annual meeting of the American Heart Association.

The problem, said Nanette Wenger, an Emory University cardiologist, is that women and their doctors tend to worry about breast cancer and osteoporosis while overlooking heart disease, even though it is the No. 1 killer of women.

“If a woman complains to her doctor about chest pain and attributes it to indigestion, he will likely agree with her,” said Wenger, “But if a male patient did that, the physician would suspect coronary disease instead.”

The problem is compounded because a physician’s best test for spotting heart disease doesn’t work as well in women as it does in men, said Dr. Douglas Miller of St. Louis University Medical Center.

In a traditional stress test, a patient walks on a treadmill to tax the heart and lungs while physicians monitor heart performance. But female patients at greatest risk for heart attacks are often in their 70s and 80s and cannot exercise vigorously, even in the absence of heart problems, Miller said.

Also, female hormones can mask symptoms of heart disease, making it difficult for physicians to make an accurate diagnosis from reading an electrocardiogram.

Because of these drawbacks, said Miller, stress tests provide false results in females at a rate that is 5 to 20 times greater than in males.

Physicians may distrust stress tests for women and balk at admitting a woman to the hospital for an expensive procedure called angiography that requires inserting a tiny tube into a coronary artery to inject dye so the area may be examined by X-ray.

“Many physicians take a wait-and-see approach with a woman who complains of chest pains, which is just the wrong thing to do if she has coronary disease,” Miller said.

When heart disease is diagnosed early and treated aggressively, women survive as well as men, Miller said, but otherwise their heart attack rate can be double that of men with comparable disease.

Researchers from Duke University presented an analysis of some 165 clinical studies that included treatment of 46,000 women and 160,000 men. That report found that women and men responded equally well to drug treatments for heart disease.

Using technology to scan a patient’s heart to measure blood flow can diagnose heart disease and assure women get proper treatment, said Miller. The scans may use radioactive isotopes released in the blood that are scanned to gauge blood flow to the heart or may rely upon ultrasound-based technology called echocardiography.

Both technologies can be useful, Miller said, and studies to prove their cost effectiveness are under way.

Wenger estimated that a decade ago a man at risk for heart disease was 10 times as likely to get the appropriate tests as a woman in the same situation.

“Today, we’re down to a ratio that’s more like two to one,” Wenger said, “So we’ve really made a lot of progress in a decade. But obviously, there is still a ways to go.”