Women and Heart Disease

Finally, researchers are paying attention to the vast differences between men and women. A new study out this week shows that the angiogram (a test in which dye is injected into the coronary arteries and are X-rayed to look for blockages), that is so effective in detecting heart disease in men, often misses symptoms in women!

When the tests turn up nothing women are given a clean bill of health, even though as many as three million women could be at risk with a buildup of fatty deposits that could ultimately interfere with blood flow to the heart. Remember, heart disease and stroke are the leading cause of death in all women over 25. Risk factors such as high cholesterol, high blood pressure, and diabetes all need to be addressed.

I asked leading cardiologist and attending interventional cardiologist at the Hackensack University Medical Center, Thomas Cocke (M.D., F.A.C.C.), about these new reports.

Dr. Manny: How are the findings of this study helping doctors identify new cases of heart disease?

Dr. Cocke: Clearly the findings suggest that a simple angiogram may not be sufficient to exclude the presence of significant coronary atherosclerosis. For women who have risk factors of coronary heart disease, and who are experiencing symptoms, further evaluation is in order. New biological markers of cardiac risk, such as the cardiac C-reactive protein (Cardiac CRP), as well as newer imaging modalities, such as a coronary calcium score, cardiac MR imaging or high resolution CT angiography may reveal patients with atherosclerosis. They can also show that a patient is at risk for a cardiac event at an earlier stage than can be detected by conventional angiography.

Dr. Manny: What tests are available to diagnose heart disease in women?

Dr. Cocke: Previous generations of CT scanners lacked the ability to adequately see the coronary arteries with enough detail to allow physicians to visualize most plaque. Newer generations such as the 16-slice and the 64-slice scanners can visualize the heart's blood vessels with ever-greater detail. This is also true of newer MR (magnetic resonance) scanners. In many cases, these tests can detect problems before a stress test or a conventional angiogram.

Dr. Manny: What are the causes of the hidden heart disease described in the medical journal?

Dr. Cocke: We have known for many years that a phenomenon called “arterial remodeling” is a part of the disease of atherosclerosis or coronary artery disease. This means that the artery dilates as plaque is deposited in the blood vessel so that in the early stages very little overall narrowing is seen on an angiogram. Late in the disease process the deposits overwhelm the body's ability to compensate by remodeling, and severe narrowing or complete blockage can occur. If this happens suddenly a heart attack often is the result. This phenomenon occurs to a varying degree in most people. This study lead us to believe that it may be a very significant problem in women, perhaps more than in men, and lead to missed diagnoses.

Dr. Manny: Who should be tested, and when?

Dr. Cocke: Certainly women who have risk factors for heart disease such as diabetes, hypertension, high cholesterol, a strong family history of heart disease or stroke, or those who smoke cigarettes, should be assessed by their physician for the presence of coronary artery disease. In addition, their physician or a cardiologist should evaluate any patient whose symptoms might broadly suggest heart disease. If coronary heart disease is suspected testing should follow. From this study a negative stress test or angiogram may not be adequate to exclude coronary disease and other testing may be in order. These tests may in fact be indicated before a stress test or angiogram.

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Dr. Manny Alvarez serves as Fox News Channel's senior managing health editor. He also serves as chairman of the department of obstetrics/gynecology and reproductive science at Hackensack University Medical Center in New Jersey. For more information on Dr. Manny's work, visit AskDrManny.com.