Angiography for female patients who have presented with symptoms of cardiac distress appear to be not effective in determining the possible extent of coronary artery disease that may actually exist, according to new research.
Therefore, new ways of diagnosing women need to be developed or perfected, according to a series of studies resulting from the Women's Ischemia Syndrome Evaluation (WISE) study sponsored by the National Heart, Lung and Blood Institute.
The series was published in a supplement to the Feb. 7 issue of the Journal of the American College of Cardiology.
“[Researchers] conclude that about one-half of the women referred to a cardiology practice for suspected ischemia do not have obstructive coronary disease, yet their prognosis is not benign in terms of future events and persistent symptoms,“ according to the introduction to the series.
In an article in the Los Angeles Times earlier this month, Dr. C. Noel Bairey Merz of Cedars-Sinai Medical Center (Los Angeles) said, “One of the biggest take-home messages from this study is that we must stop falsely reassuring women when their arteries are open.“
Instead of large blockages, postmenopausal women are more prone to a condition that leads to a narrowing of the microvasculature throughout the coronary artery system, rather than a large clump of plaque in one artery that can easily be seen with angiography.
“The WISE study has further demonstrated that micro-vascular ischemia is frequently associated with the signs and symptoms of this large cohort of women with nonobstructive coronary arteries,“ the researchers said.
That's important to know, since more than a quarter of a million women die each year in the U.S. from ischemic heart disease “and its related conditions, and current projections indicate that the this number will continue to rise with our aging population.“
Specifically, according to the State-of-the-Art portion of the series, the Duke Activity Status Index (DASI), a 12-question self-report, “provides valid information predictive of adverse cardiovascular outcomes . . .“
“Perhaps this instrument, if validated in other female populations, should be administered in the office as a part of our diagnostic evaluation,“ according to the study introduction.
Also, the study suggests that using positron emission tomography (PET) and MR may work better than the currently used single-photon emission computed tomography (SPECT) testing in women.
The study said that because SPECT perfusion techniques measure deficits based upon “differences in regional distribution of blood flow that is comparatively assessed . . . across the myocardium,“ it is possible that “in the setting of global coronary vascular dysfunction (endo-thelial or microvascular dysfunction), the SPECT study could show no regional differences in the distribution of flow and appear normal,“ even when there was cause for concern.
However, researchers also suggested that the preferred use of PET and MRI had yet to be established in the current literature.
The study said “recent estimates from the Centers for Disease Control and Prevention [Atlanta] reveal that 38% of all deaths in women are related to coronary heart disease, as compared with 22% resulting from cancer.
“Indeed, since 1984, more women than men have died annually from IHD, refuting the notion that this is a 'man's disease' and suggesting that it might be relabeled a 'woman's affliction,'“ according to the State-of-the-Art portion of the study.
The goal of the studies is to create a “heightened awareness of women at risk of IHD and a different approach than that used in men, [which is] necessary to allow for diagnosis before late stages develop,“ the introduction reported.
The study also offers some instruction of its own, suggesting that with the information gleaned from the WISE studies, “consensus need to be reached on an algorithm of diagnostic testing to better assure an accurate early diagnosis of IHD.“
As the number of women dying from ischemic heart disease outpaces men, there is a suggestion that additional research must focus on “gender-specific issues“ in order to address the societal burden and costs related to these demographic shifts in IHD that place women in the majority of those impacted.“
For example, there are differences in the way women who are menopausal vs. premenopausal respond to various testing methods.
“This significant burden of the disease in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike.“