Women and Heart Disease - Conclusions I
The first article deals with actual differences between men and women concerning the physiology of angina (chest pain resulting when not enough oxygen flows to the heart muscle). Coronary artery disease was defined as more than 50% blockage ("stenosis" is the technical term) in more than one coronary artery. In women, only 39% of patients with angina have this type of blockage. Their angina is thought to be due to blockage at the sub-artery level. This causes different symptoms, which in turn, causes a problem for diagnosis and treatment: 65% of women with angina have normal coronary arteries, but continue to suffer worsening symptoms. The major recommendation from this study is that "future research should be targeted to better characterizing symptoms in women with coronary artery disease". Likewise, "diagnosis effectiveness" needs to be improved - good diagnosis of ischemic heart disease needs to be more timely and accurate. In addition, dissemination and communication to the healthcare community and to the public needs to be more effective.
Another aspect presented in this series, is the necessity to improve determination of the CHD risk factors in women. It may also become possible to provide some simple screening tests for women, such as retinal arteriolar narrowing (retinal blood vessel size changes - a marker of microvascular damage from aging, hypertension, and inflammation).
So what can women learn from this?
I believe that these articles express a general lack of comprehensive knowledge about the detailed physiology, diagnosis and treatment of heart disease in women. In addition, it is very likely that many physicians (who are too busy to read all the articles on all topics in any detail...) may not be aware of the differences between men's and women's symptoms. On the positive side, recognition of a deficiency is a first step towards rectification of the issue. It also puts women on notice that they must be aware of the potential symptoms, and not hesitate to demand that their physician send them for in-depth diagnostic testing if the physician him/herself is unable to determine their exact cause.
In the following, we will list possible symptoms that women have that may indicate a potential coronary problem.