and Medicine for Seniors
More Women to Live Longer Due to Gender-Specific
Research of Heart Disease Diagnosis
Clinicians now have the tools and knowledge to more
accurately detect, determine risk and develop treatment strategies for heart
disease in women
Jennifer H. Mieres, M.D., lead author of the
statement and professor of Cardiology & Population Health, R
Hofsrta North Shore-LIJ School of Medicine in Hempstead, New
York. copyright American Heart Association
June 17, 2014 – More women – no doubt – will live
to an older age because the diagnoses of coronary heart disease in women
has become more accurate due to gender-specific research that has
clarified the role of obstructive and non-obstructive coronary artery
disease in contributing to ischemic heart disease in women, according to
a statement by the American Heart Association published in the journal
“For decades, doctors used the male model of
coronary heart disease testing to identify the disease in women,
automatically focusing on the detection of obstructive coronary artery
disease,” said Jennifer H. Mieres, M.D., lead author of the statement
and professor of Cardiology & Population Health, R Hofsrta North Shore-LIJ
School of Medicine in Hempstead, New York.
“As a result, symptomatic women who did not have
classic obstructive coronary disease were not diagnosed with ischemic
heart disease, and did not receive appropriate treatment, thereby
increasing their risk for heart attack.”
disease, also known as coronary heart disease, occurs because
of a decreased blood flow to the heart muscle, most often due to
coronary atherosclerosis from the buildup of
the coronary arteries. This plaque can result in
obstructions in the
arteries, which diminishes blood flow to the heart muscle,
reduces the heart’s oxygen supply, and damages the heart muscle –
resulting in heart attack and a decrease in the heart’s pumping ability.
Non-obstructive coronary artery disease and
coronary microvascular disease, which is more common in women, occur
because of damage to small arteries or the inner lining of the main
arteries leading to the heart, which can cause them to spasm, blocking
blood flow. Some women may have both
microvascular disease and plaque build-up in the small
• Women are more likely than men to be diagnosed
with dysfunctions of the smaller coronary arteries and the lining of the
coronary arteries, known as non-obstructive coronary heart disease.
• Women previously diagnosed as having “false
positive” stress tests may have non-obstructive coronary disease,
placing them at risk for heart attack.
In the past, there was a lack of recognition of the
importance of non-obstructive coronary disease in women, leading to
diagnoses of “false positive”
and a lack of appropriate treatment. However, new research indicates
that women with non-obstructive coronary artery disease and abnormal
stress tests are in fact at an elevated risk of heart attack.
Women also experience a broader range of ischemic
heart disease symptoms than men, and have a different pattern and
distribution of pain symptoms, often not located in the chest.
Additionally, women’s symptoms are frequently associated with mental or
emotional stress, and are less likely to result from physical exertion
compared to men.
The statement is intended for women who have the
symptoms of ischemic heart disease, including the classic symptoms of
left sided chest pain/pressure, jaw pain, upper back pain, widespread
“indigestion,” and other symptoms not localized to the chest.
Recommendation highlights include:
• Women with suspected ischemic heart disease
should discuss the benefits and risks of diagnostic tests with their
healthcare provider – for example, a woman of child-bearing age may want
to avoid tests that require exposure to radiation.
• Healthcare professionals should consider
whether a woman is at low, intermediate, or high risk for ischemic heart
disease when determining the appropriate diagnostic tests for their
patients. Risk level is based partly on age combined with risk factors,
such as diabetes and high blood pressure.
• Health care professionals, for the first time,
should consider a woman’s functional ability – her ability to carry out
the activities of daily living to determine the type of diagnostic
testing needed. Women with low functional disability are now considered
at increased risk for heart attack.
• Women with the lowest risk should not undergo
diagnostic testing; women at slightly higher risk should first undergo a
treadmill exercise ECG (electrocardiogram); and symptomatic women with
warning signs, including functional disability, might be candidates for
cardiac MRI (magnetic resonance imaging) or cardiac CT angiography
(computed tomography that looks at the heart).
“This new and better understanding of women and
ischemic heart disease arms clinicians with the knowledge and tools
needed to accurately detect, determine risk and treatment strategies for
the disease in symptomatic women who were previously un-diagnosed.,”
The statement’s co-chair is Leslee Shaw, PhD.; and
other co-authors are Martha Gulati, M.D., M.S Noel Bairey Merz, M.D.;
Daniel S. Berman, M.D.; Thomas C. Gerber, M.D., Ph.D.; Sharonne N.
Hayes, M.D.; Christopher M. Kramer, M.D.; James K. Min, M.D.; L. Kristin
Newby, M.D., M.H.S.; J.V. (Ian) Nixon, M.D.; Monvadi B. Srichai, M.D.;
Patricia A. Pellikka, M.D.; Rita F. Redberg, M.D., M.Sc.; and Nanette K.
Wenger, M.D. Author disclosures are on the manuscript.
• For more information about heart disease and
• To learn about women and heart disease, visit
Go Red For Women.