Women & men differ in heart disease traits and treatment

The researchers focused on data from 10,500 of the patients who underwent coronary angiography. This approach, common in the U.S. but less common in other countries, sends a tiny tube called a catheter into the groin, up through a patient's arteries and into the vessels surrounding the heart. The catheter releases dye that's visible on X-ray images -- allowing doctors to see blood vessels and determine if they might be blocked or narrowed.

The extent of blockage, called stenosis, is classified according to the percentage of the vessel's cross-section that has been filled by plaque or clots lining or clinging to the vessel's inner walls. For the study, patients were considered to have mild stenosis if less than 50 percent of a major blood vessel's cross-section was blocked, and to have coronary artery disease if they had a 50 percent or greater blockage in at least one major vessel.

The study also looked at the levels of certain enzymes that can be measured in the blood to determine if a heart attack really occurred. Women in the study tended to be older and to have more health problems than the men, but their rate of cardiac enzyme release was about the same.

Despite similar rates of enzyme release, women were more than twice as likely as men to have normal or mild stenosis evident on their angiograms.

"This lack of clear evidence of blockage, even in the presence of elevated enzyme levels and a positive stress test, may be what causes so many doctors to scratch their heads about female patients with chest pain," says Eagle.

Women were also statistically less likely than men to undergo percutaneous intervention (PCI) such as angioplasty, or bypass surgery. This may make sense in light of the fact that they were less likely to have severe obstructive blockages on their angiograms the kinds of blockages targeted by such therapies. Not surprisingly, women also had a lower rate of previous PCI or bypa

Contact: Kara Gavin
University of Michigan Health System

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