WISE Study of Women and Heart Disease
Yields Important Findings On Frequently Undiagnosed Coronary Syndrome
In as many as 3 million U.S. women with coronary heart disease,
cholesterol plaque may not build up into major blockages, but instead
spreads evenly throughout the artery wall. As a result, diagnostic
coronary angiography reveals that these women have “clear”
arteries—no blockages—incorrectly indicating low risk.
Despite this, many of these women have a high risk for heart attack,
according to newly published research from the National Institutes
of Health.
In women with this condition, called coronary microvascular syndrome,
plaque accumulates in very small arteries of the heart, causing
narrowing, reduced oxygen flow to the heart, and pain that can be
similar to that of people with blocked arteries, but the plaque
does not show up when physicians use standard tests. As a result,
many women go undiagnosed, according to findings from the National
Heart, Lung, and Blood Institute’s (NHLBI) Women’s Ischemia
Syndrome Evaluation (WISE) study. Insights from the study are published
in a special supplement to the February 6 issue of the Journal
of the American College of Cardiology, available online January
31.
“When a diagnosis of this condition is missed, women are
not treated for their angina and high cholesterol and they remain
at high risk for having a heart attack,” said NHLBI Director
Elizabeth G. Nabel, M.D. “This study and the high prevalence
of coronary microvascular dysfunction demonstrate that we must think
out of the box when it comes to the evaluation and diagnosis of
heart disease in women.”
The National Institutes of Health initiated WISE in 1996 to increase
scientific knowledge about ischemic heart disease in women. WISE
aimed to develop accurate diagnostic approaches for ischemic heart
disease detection in women, to better understand the ways in which
heart disease develops in women including the significance of ischemia
without coronary blockages in women, and to evaluate the influence
of hormones, on ischemic heart disease development and diagnosis.
“So much of our understanding of the underpinnings of heart
disease and heart attack, and the basis for our standard methods
of diagnosis and treatment are the result of research conducted
on men,” said C. Noel Bairey Merz, Cedars-Sinai Medical Center
and the WISE study chairperson. “Through clinical experience,
many critical questions arose about how the disease may manifest
differently in women, and how diagnostic techniques may need to
be used differently in order to prevent more heart attacks and save
lives.”
WISE investigators found that the majority of women with “clear”
angiography who are not diagnosed will continue to have symptoms,
a declining quality of life, and repeated hospitalizations and tests.
“Through WISE, we have made tremendous progress toward better
understanding of heart disease in women. Too often women are tested
again and again, go untreated, and still have high risk for heart
attacks, “ said George Sopko, MD, NHLBI project officer for
WISE. “As clinicians we must systematically examine women
for evidence of any blockages and initiate intensive treatment for
their risk factors.”
Authors of six review papers providing insight on WISE conclude
that the study has provided the groundwork for additional controlled
clinical studies of diagnostic tools and treatments in women with
ischemic heart disease.
Additional study conclusions from WISE appear in the same JACC
edition:
- Identifying Candidates for Exercise Stress Testing:
Using the evaluative tool Duke Activity Status Index (DASI) in
women with heart disease symptoms prior to stress testing can
help determine who would be eligible for an exercise stress test
versus a stress test using intravenous medications to increase
the heart load instead of exercise. Current guidelines offer physicians
little guidance on how to identify women who would not be able
to sufficiently complete the exercise test. The DASI has been
previously validated as a useful tool for determining functional
capacity.
- Low Coronary Flow and Scores on Function Test Indicate Poor
Outcomes: Women who have low DASI scores also have lower
coronary flow velocity, a combination which may explain the poor
outcomes seen for women with heart disease but no blocked arteries.
- Role of Pre-menopausal Hypertension in Disease Risk:
Women who have high blood pressure before menopause, especially
high systolic blood pressure, should be considered at a higher
risk and treated accordingly.
Resources:
NHLBI is part of the National Institutes of Health (NIH), the
Federal Government’s primary agency for biomedical and behavioral
research. NIH is a component of the U.S. Department of Health and
Human Services. NHLBI press releases and other materials including
information about women and heart disease are available online at
www.nhlbi.nih.gov.
|