A Faulty All-Clear
Women with normal angiograms may still be in trouble
To gauge the likelihood of heart attack, doctors often peek inside the heart's major arteries: Big buildups of cholesterol-laden plaque mean big trouble, while clear arteries are a sign of low risk. But in women, that can be a false and dangerous assumption, according to research unveiled last week.
An investigation into how heart disease looks in females, sponsored by the National Institutes of Health, has shown that the tiniest arteries of the heart are where danger lurks for as many as 3 million American women. These arteries can't be checked out using a conventional angiogram--an X-ray taken after dye is injected--but can become clogged even when the major vessels are not. And they're crucial to a healthy heart; stop them up, and oxygen flow is reduced, setting the stage for a heart attack. Doctors who think of heart disease in terms of how it affects men need to be careful not to dismiss signs of trouble in women, says Noel Bairey Merz, medical director of women's health at Cedars-Sinai Medical Center in Los Angeles and chair of the Women's Ischemia Syndrome Evaluation (WISE), which began tracking about 1,000 women in 1996.
Scary signs. Screening women with symptoms such as chest pain, fatigue, and nausea for coronary microvascular syndrome, as the condition is called, "possibly should become standard," says Merz. One effective test, a variation of a CT scan, is more sophisticated than angiography, however, and may not be practical for every local hospital to offer. Another option is a special kind of stress test that uses an injection. Other tests are now being studied for their ability to accurately detect the problem.
Merz is continuing to follow the women in the WISE study, whose latest findings will be published in the Journal of the American College of Cardiology . She's also studying what treatment may specifically target problems in the smaller vessels. In the meantime, women who suspect they may be in danger should insist that their doctors take them seriously. (An unrelated study released last week found that women with chest pain are less likely to be treated than men.) And the standard regimen of drugs given after a heart attack can help women who have had one avoid a second.
This story appears in the February 13, 2006 print edition of U.S. News & World Report.