In a new study, researchers found that women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have much more chest pain caused by plaque build-up, yet less extensive disease as compared with men.
The study is the first to look at sex differences within this patient population.
Because women were more than three times as likely as men to have a 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.
The results beg the question of why and what might be different about the biology of how plaque forms in men and women, especially as more severe angina is typically associated with higher rates of events like a heart attack or death.
According to the team, the heart has nerves that can sense when there isn’t enough blood flow, but doctors can’t always tell if those nerves have been activated by a large amount of heart muscle or a smaller amount.
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.
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 lead author of the study is Harmony Reynolds, MD, director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health.
The study was presented at the American College of Cardiology’s Annual Scientific Session Together with the World Congress of Cardiology.
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