SOURCE: Harvard Medical School HEALTHBeat email newsletter
DATE: December 1, 2007
EXCERPTS: "A revolution in thinking about coronary blood vessels could change the way women’s heart problems are diagnosed and treated. ... findings from the federally funded Women’s Ischemia Syndrome Evaluation (WISE) study — a landmark investigation into ischemic heart disease in women — are helping us to understand that heart disease, like cancer, is not one, but several disorders. Discoveries from the WISE study suggest that many women have a form of heart disease called coronary microvascular dysfunction that isn’t detected by standard diagnostic procedures and thus goes unrecognized and untreated. .... microvessel disease came as an epiphany. It helped explain why so many women with IHD were misdiagnosed and undertreated: The standard protocol identified only coronary artery obstructions. Microvessel disease could also help explain why so few women have the classic crushing chest pain that signals coronary artery disease. Instead, they feel diffuse discomfort, exhaustion, or shortness of breath under stress or even during daily routines — symptoms that are nonspecific and less dramatic than those that herald a blockage caused by a blood clot. As vessels lose their resilience, blood flow is reduced, and the heart muscle, deprived of oxygen, gradually dies, resulting in congestive heart failure. ... The WISE data may also explain why women who undergo angioplasty and bypass surgery don’t fare as well as men. These women may have both coronary artery disease and unrecognized microvessel disease. In such cases, opening the arteries isn’t sufficient. ... Pay attention to symptoms. Certain seemingly unrelated symptoms — fatigue, depression, shortness of breath — could be preludes to a serious cardiac event. Don’t be shy about seeking medical help for these symptoms. .... Talk to your doctor. If you’re at high risk for or have symptoms of heart disease, such as unexplained fatigue or shortness of breath, discuss the WISE findings with your clinician. She or he may want to reevaluate your care, especially if you’ve had a “false-positive” stress test (that is, the stress test indicated a problem but further testing was negative). ... " more
RELATED PUBMED LINKS:
Pepine CJ, von Mering GO, Kerensky RA, Johnson BD, McGorray SP, Kelsey SF, Pohost G, Rogers WJ, Reis SE, Sopko G, Bairey Merz CN; WISE Study Group. Phytoestrogens and coronary microvascular function in women with suspected myocardial ischemia: a report from the Women's Ischemia Syndrome Evaluation (WISE) Study. J Womens Health (Larchmt). 2007 May;16(4):481-8.
Lerman A, Sopko G. Women and cardiovascular heart disease: clinical implications from the Women's Ischemia Syndrome Evaluation (WISE) Study. Are we smarter? J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S59-62.
Bairey Merz CN, Shaw LJ, Reis SE, Bittner V, Kelsey SF, Olson M, Johnson BD, Pepine CJ, Mankad S, Sharaf BL, Rogers WJ, Pohost GM, Lerman A, Quyyumi AA, Sopko G; WISE Investigators. Insights from the NHLBI-Sponsored Women's Ischemia Syndrome Evaluation (WISE) Study: Part II: gender differences in presentation, diagnosis, and outcome with regard to gender-based pathophysiology of atherosclerosis and macrovascular and microvascular coronary disease.
J Am Coll Cardiol. 2006 Feb 7;47(3 Suppl):S21-9. Review.
Merz NB, Johnson BD, Kelsey PSF, Reis SE, Lewis JF, Reichek N, Rogers WJ, Pepine CF, Shaw LJ; Wise Study Group. Women's Ischemia Syndrome Evaluation. Diagnostic, prognostic, and cost assessment of coronary artery disease in women. Am J Manag Care. 2001 Oct;7(10):959-65.
Reis SE, Holubkov R, Conrad Smith AJ, Kelsey SF, Sharaf BL, Reichek N, Rogers WJ, Merz CN, Sopko G, Pepine CJ; WISE Investigators. Coronary microvascular dysfunction is highly prevalent in women with chest pain in the absence of coronary artery disease: results from the NHLBI WISE study. Am Heart J. 2001 May;141(5):735-41.
Also see search results for "WISE study AND women AND heart"
Comments