Now research finds that women's disease is actually very different from that typically found in men, with a variety of complex underlying factors. Further, because women's ischemic disease often evades detection through traditional diagnostic techniques that are based on men's disease, it may continue to cause symptoms but remain undiagnosed until progressing to a critical stage.
An update on findings from The Women's Ischemia Syndrome Evaluation (WISE) Study, a multi-center, long-term investigation sponsored by the National Heart, Lung and Blood Institute, is presented in a supplement to the Feb. 7, 2006 issue of the Journal of the American College of Cardiology. Cardiologist C. Noel Bairey Merz, M.D., chairs the WISE study, which was launched in 1996. Bairey Merz serves as medical director of the Preventive and Rehabilitative Cardiac Center and medical director of Women's Health at Cedars-Sinai Medical Center. She also holds the Women's Guild Chair in Women's Health.
When patients seek medical care for chest pain, diagnosticians typically look for a "culprit" obstructive lesion – plaque that is blocking an artery. But in many women, two areas of dysfunction – one in the cells lining coronary arteries and another in the tiny vessels branching within the heart itself – combine to deprive the heart muscle of oxygen. "Functional rather than structural abnormalities of the coronary circulation may be the hallmark of the disease in women," according to one of the journal articles.
The WISE researchers offer the first description of this female-specific vascular disorder, "a global pattern of dysfunction in the macro- and microcirculation." Although the "diffuse atherosclerosis" that many women experience is not seen on coronary angiography, it results in abnormal resistance that limits blood flow to the heart tissue. But without angiographic evidence of a blocked artery, a woman's symptoms are likely to be discounted.
Women's symptoms often are different than men's, too, contributing to under-diagnosis. As the disease is progressing, women may describe non-specific symptoms such as fatigue, sleep disturbance and shortness of breath. The WISE researchers recommend that clinicians become more aware and aggressive in investigating these early complaints.
The journal articles on WISE studies, accompanied by discussions provided by several experts in the field, provide insight on a wide variety of subjects, including the array of gender-specific factors contributing to women's manifestation of heart disease and implications for innovative diagnostic and evaluation procedures. Among topics and findings:
WISE was designed to study diagnostic testing and pathophysiology of IHD in women and how sex hormones and other gender-specific findings influence the clinical aspects of the disease. From 1996 to 2000, 936 women referred for angiograms because of chest pain and suspected ischemia were enrolled. Several other studies have also grown out of this major project.
The WISE study is supported by NHLBI contracts NO1-HV-68161, NO1-HV-68162, NO1-HV-68163, and NO1-HV-68164, and grants UO1-HL64829-01, UO1-HL64914-01, and UO1-HL65924-01. GCRC grant MO1-RR00425 from the National Center for Research Resources, and grants from the Gustavus and Louis Pfeiffer Research Foundation, Denville, N.J., and the Ladies Hospital Aid Society of Western Pennsylvania, Pittsburgh.
Journal of the American College of Cardiology