Good News For Women's Hearts
Armed with two recent research findings, Doctors can now diagnose cardiac conditions in females more effectively.
More women lose their lives to heart disease than to any other illness. But two recent advances in cardiac care for women may help reduce those numbers.
1. A Backstop for Assessing Angina
The first change relates to all women who have, or are at risk for, angina—pain or discomfort in the chest, arms, neck or jaw that occurs when the heart is not receiving enough blood flow. The most common cause of angina is coronary artery disease, which blocks the arteries feeding the heart muscle.
Angina is typically diagnosed with a stress test, of which there are many different types. The heart can be stressed with either exercise or a synthetic medication. Images of the heart can then be taken with an electrocardiogram or an echocardiogram—an ultrasound of the heart. Nuclear radiotracers, which involve radiation, are another option. All of these tests will most often reveal the blocked arteries and/or restricted blood flow to the heart that is causing angina. Blocked arteries can be opened with medication or an angioplasty procedure.
However, some women with angina cannot be diagnosed with traditional stress tests. “When there is chest pain but no evidence of blockages, they may be in the tiny microvasculature, which you can’t see on these tests, or in the endothelium—the lining of blood vessels—which don’t react as they should,” says Anthony Patrello, M.D., an interventional cardiologist with Bergen Medical Associates. Until recently it was believed that these women with no obvious blockages faced no danger. But recent research shows that they are at increased risk for cardiac events such as a heart attack or stroke.
For these women—and the literature suggests they may be as many as 57 percent of all women with angina—another new type of stress test done with a chemical stressor, such as the drug regadenoson, and magnetic resonance imaging (MRI) is more appropriate. “A stress MRI can show evidence of microvascular disease and endothelial dysfunction better than the other tests,” Dr. Patrello says. “There is no radiation, and the image quality is fantastic.”
Women with this condition are treated aggressively with medications and closely watched by their cardiologist, usually for the rest of their lives.
2. Warning Factors in Pregnancy
The second recent advance involves pregnancy. Two common complications of pregnancy are gestational high blood pressure, called preeclampsia, and gestational diabetes. Both typically end once the baby is delivered and, until recently, no one thought there were any lasting implications. However, recent European studies reveal that women who had one or both of these conditions during pregnancy are at an increased risk of developing heart disease later in life—sometimes 20 or 30 years down the road.
“For women with preeclampsia, the risk of heart attack goes up twofold, and the risk for stroke and blood clots is about 1.8 times higher,” says Dr. Patrello. “It’s a really significant risk.”
In response to this news, the American College of Cardiology (ACC) recently updated guidelines to encourage doctors to ask women patients about their pregnancy health histories. If women experienced these conditions, they should begin seeing a cardiologist.
Treatments should be aggressive, according to the ACC. “And they should start early,” says Jacqueline Hollywood, M.D., a cardiologist who leads the Women’s Cardiac Institute at Hackensack University Medical Center, which is dedicated to the early detection and treatment of heart disease and provides education about nutrition, exercise, smoking cessation and other controllable risk factors.
“We don’t want to alarm people,” she says. “We are simply watching more closely. In the past, once blood pressure was back to normal these women would be sent on their way. Now, we are more vigilant with routine physical exams to monitor blood pressure and cholesterol.”
And doctors may be a bit quicker to treat moderately high blood pressure or other conditions with medication. “Instead of watching and waiting, it might be appropriate to jump on it a little bit sooner,” Dr. Patrello says.
The important message to take from both these developments, says Dr. Hollywood, is that heart disease is not “a man’s problem.” In fact, despite medicine’s advance, more women than men are dying of heart disase every year. “The take-home point here is that it’s all about early detection, modifying risk factors and proper treatment,” says the doctor. —David Levine
