Women carry heavier burden of chest pain, but less artery narrowing

March 18, 2020

Women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have significantly more chest pain caused by plaque build-up, yet less extensive disease as compared with men, according to new research presented at the American College of Cardiology's Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The study, which included a subset of women and men from the ISCHEMIA trial who received abnormal stress test results indicative of moderate to severe ischemia, is the first to look at sex differences within this patient population. Those with open arteries, or no obstructive coronary artery disease, on further testing were excluded from this analysis. Because women were more than three times as likely as men to have non-obstructive disease (34% vs. 11%), women only comprised 23% of study participants, with 4,011 men and 1,168 women ultimately being enrolled. Women in the study had 38% higher odds of having more chest pain than men, even after considering other factors such as age, race, stress test findings, medication use, smoking, diabetes, high blood pressure, prior heart attack, kidney function and overall heart function.

"Women are having more chest pain even though they have less plaque on imaging, and yet they have very abnormal stress test results," said Harmony Reynolds, MD, director of the Sarah Ross Soter Center for Women's Cardiovascular Disease at NYU Langone Health and the study's lead author.

The results beg the question of why and what might be different about the biology of how plaque forms in men and women, Reynolds said, especially as more severe angina is typically associated with higher rates of events like heart attack or death.

"The heart has nerves that can sense when there isn't enough blood flow, but we can't always tell if those nerves have been activated by a large amount of heart muscle or a smaller amount," she said. "Just like a small cut on your finger can really sting and hurt and yet it may hardly look like anything. So when it comes to the burden of chest pain in these women, is it because the activation of nerve endings in a relatively smaller amount of heart muscle will raise the red flag in a woman's brain differently, or is it because there are other factors going on in women, like small vessel disease, that we aren't assessing with the tests that we are using?"

The results underscore the need for more research and for clinicians to adopt a dual focus to prevent cardiovascular events and worsening disease, as well as to better control symptoms to improve patients' quality of life.

For this study, patients from the ISCHEMIA trial were included based on very abnormal stress test findings and presence of some degree of narrowed coronary arteries. Women were found to have less ischemia on stress tests than men even though they had more angina. Those tests included stress nuclear tests, stress echocardiograms and stress MRI tests. Chest pain symptoms were assessed using the validated Seattle Angina Questionnaire, which asked questions about how often patients experience chest pain and whether it affects daily activities, such as walking briskly, lifting, cooking, vacuuming, bathing and more.

"Even when women have very abnormal stress tests--more characteristic of what we think of as typical 'male type' coronary heart disease--they have less extensive atherosclerosis and yet they are still having more symptoms as compared to men," Reynolds said. "These findings suggest that just because there may not be as much plaque, many women may have chest pain that limits their daily activities, and we have medicines that can improve chest pain from heart disease."

This analysis is limited in that it only includes people with very abnormal stress tests. In addition, people whose symptoms were uncontrollable with medication could not be enrolled in the study.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.
-end-
ACC.20/WCC will take place March 28-30, bringing together cardiologists and cardiovascular specialists from around the world to share the newest discoveries in treatment and prevention. Follow @ACCinTouch, @ACCMediaCenter and #ACC20/#WCCardio for the latest news from the meeting.

The American College of Cardiology envisions a world where innovation and knowledge optimize cardiovascular care and outcomes. As the professional home for the entire cardiovascular care team, the mission of the College and its 54,000 members is to transform cardiovascular care and to improve heart health. The ACC bestows credentials upon cardiovascular professionals who meet stringent qualifications and leads in the formation of health policy, standards and guidelines. The College also provides professional medical education, disseminates cardiovascular research through its world-renowned JACC Journals, operates national registries to measure and improve care and offers cardiovascular accreditation to hospitals and institutions. For more, visit acc.org.

American College of Cardiology

Related Heart Attack Articles from Brightsurf:

Top Science Tip Sheet on heart failure, heart muscle cells, heart attack and atrial fibrillation results
Newly discovered pathway may have potential for treating heart failure - New research model helps predict heart muscle cells' impact on heart function after injury - New mass spectrometry approach generates libraries of glycans in human heart tissue - Understanding heart damage after heart attack and treatment may provide clues for prevention - Understanding atrial fibrillation's effects on heart cells may help find treatments - New research may lead to therapy for heart failure caused by ICI cancer medication

Molecular imaging identifies link between heart and kidney inflammation after heart attack
Whole body positron emission tomography (PET) has, for the first time, illustrated the existence of inter-organ communication between the heart and kidneys via the immune system following acute myocardial infarction.

Muscle protein abundant in the heart plays key role in blood clotting during heart attack
A prevalent heart protein known as cardiac myosin, which is released into the body when a person suffers a heart attack, can cause blood to thicken or clot--worsening damage to heart tissue, a new study shows.

New target identified for repairing the heart after heart attack
An immune cell is shown for the first time to be involved in creating the scar that repairs the heart after damage.

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.

A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.

Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.

Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.

Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.

How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.

Read More: Heart Attack News and Heart Attack Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.