Patient Education: Recent Research


Data from two separate studies were used for this analysis. Women with suspected ischemia and evidence of obstructive CAD on angiography from the Women’s Ischemia Syndrome Evaluation (WISE) study were compared to women from the St James Women Take Heart (WTH) project, a community-based sample of women with no history of heart disease at baseline, who were followed for 10 years. Nonobstructive disease was defined as all coronary arteries with less than a 50% stenosis. Two groups of WISE subjects were created: one with no evidence of CAD and the other with nonobstructive CAD. Subjects from WISE were matched on age and race with subjects from WTH. Mean follow-up time was 5.2 years. Outcomes of interest included CV events (myocardial infarction, stroke, heart failure requiring hospitalization), and death.



A total of 540 women from the WISE study (58.9% with normal coronary arteries and 41.1% with nonobstructive CAD) were compared to 1,000 women from the WTH study. Rates of obesity, family history of CAD, hypertension, and diabetes were lower among the women in the community sample compared to the WISE women. After adjustment for CV risk factors, the 5-year annualized CV event rates were highest for women with nonobstructive (event rate 16%), followed by women with normal coronary arteries (event rate 7.9%). Women in the community sample were observed to have the lowest event rate at 2.4%. The CV event rate was highest among women with four or more CV disease (CVD) risk factors: 25.3% for women with nonobstructive CAD, 13.9% for women with normal coronary arteries, and 6.5% for asymptomatic women. Increasing age was significantly related to event rates among women with nonobstructive CAD.



The authors concluded that women with symptoms and signs suggestive of ischemia, but without obstructive CAD, are at risk for future CVD events, particularly those with multiple CVD risk factors.



These findings support the need for risk factor prevention, even when coronary arteries appear nonobstructed or normal by angiography. Whether risk factor modification will prevent events in these women remains unanswered.


Author of Article: Elizabeth A. Jackson, M.D., F.A


Article Posted on August 5, 2009




A lot of women are concerned about breast cancer, and they know about the importance of screening for it by getting a mammogram. What a lot of women don’t know is that heart disease is actually more of a threat to their health than breast cancer is. In fact, coronary heart disease (CHD) is the leading cause of death for women in the United States.

Most heart attacks occur when there is a complete blockage (100%) or a near-complete blockage of one of the coronary arteries that feed the heart muscle with oxygen-rich blood. Angina, which is heart or chest pain that is not a heart attack, can occur when more than 50% of an artery is blocked but usually occurs when an artery is more than 70% blocked. 

It seems that the type of CHD that women have is different from the type that men have. For women, CHD can occur in smaller vessels. Women also have a higher prevalence of nonobstructive CHD, which is present when patients have angina and an abnormal stress test result but have blockages of less than 50% in the coronary arteries that feed the heart muscle.

Doctors have long debated what the presence of nonobstructive CHD means for their patients. Now, a recent article published in the Archives of Internal Medicine sheds some light on the matter. Until now, cardiologists could not say for sure if women with nonobstructive CHD had an increased risk of cardiovascular events, such as a heart attack.

The researchers used the results from 2 big studies that were done to answer other questions about women’s heart health. These studies are called the Women’s Ischemia Syndrome Evaluation (WISE) and the St. James Women Take Heart (WTH) Project. Using the information gathered in those 2 studies, the researchers in the current study found that women who had signs and symptoms of ischemia (a lack of blood to the heart) but who did not have obstructive CHD are at risk for future cardiovascular events. The women at greatest risk were those who also had many other risk factors for heart disease.

The results of this study are very striking. They remind the cardiology community once again how important it is to understand the differences between women’s and men’s heart symptoms and to aggressively treat heart disease risk factors, such as diabetes and high blood pressure.


Posted from Dr. Guilherme Silva, M.D.