Boston – For women experiencing symptoms of coronary heart disease (CHD), a common cardiac CT scan may underestimate the extent of arterial plaque buildup compared to men with similar complaints, according to a new study. Despite this difference in detected plaque, the research, published in Circulation Cardiovascular Imaging, found that the risk of a major cardiovascular event – such as a heart attack or stroke – was roughly equivalent for both sexes. This finding underscores the challenges in accurately assessing heart disease risk in women and highlights the demand for improved diagnostic approaches.
The study, with a DOI of 10.1161/CIRCIMAGING.125.019011, analyzed data from a clinical trial and adds to a growing body of evidence demonstrating that heart disease often presents differently in women than in men. Recognizing these differences is crucial for timely and effective treatment.
The Challenge of Atypical Symptoms
For decades, medical understanding of heart attack symptoms has been largely based on observations of men. The “classic” presentation – crushing chest pain radiating down the left arm – is frequently cited, but this isn’t always the case, particularly for women. Research consistently shows that women are more likely to experience “atypical” symptoms, making diagnosis more difficult. These can include pain in the upper abdomen, neck, or back, as well as nausea, vomiting, and shortness of breath. A 2023 review published in the American Heart Association journal Circulation detailed the significant delays in treatment women face due to these less-recognized symptoms.
“The fact that women often present with different symptoms than men is well-established,” explains Dr. C. Noel Bairey-Merz, Director of the Women’s Heart Center at Cedars-Sinai Medical Center, in a separate interview with time.news. “This can lead to misdiagnosis or delayed diagnosis, which can have serious consequences.” She was not directly involved in the Circulation Cardiovascular Imaging study but has extensively researched sex differences in heart disease.
What the Kardio-CT Study Revealed
The recent study focused on the use of cardiac CT scans – a non-invasive imaging technique that allows doctors to visualize the coronary arteries and detect the presence of plaque. Researchers found that, when presented with similar symptoms, women tended to have a lower calculated plaque score on these scans compared to men. However, and importantly, this lower plaque score did not translate to a lower risk of experiencing a major cardiovascular event. This suggests that traditional methods of assessing heart disease risk based solely on plaque burden may be insufficient for women.
“The study doesn’t mean women are getting ‘off easy’ with less plaque,” clarifies Dr. Bairey-Merz. “It suggests that the *type* of plaque, its composition, or other factors not captured by a standard CT scan may be playing a more significant role in women’s risk.” She points to research indicating that women are more likely to have non-obstructive coronary artery disease – blockages that don’t significantly narrow the arteries – but still experience symptoms and adverse events.
Beyond Plaque: Exploring Alternative Risk Markers
The findings reinforce the need to move beyond simply counting plaque and to explore other potential risk markers that may be more relevant for women. These include:
- Coronary Microvascular Dysfunction: Problems with the small blood vessels in the heart, often not visible on standard scans.
- Inflammation: Elevated levels of inflammatory markers in the blood.
- Endothelial Dysfunction: Impaired function of the inner lining of blood vessels.
- Stress Testing: Assessing heart function during physical exertion, which can reveal abnormalities not apparent at rest.
Researchers are also investigating the role of hormones, such as estrogen, in protecting women from heart disease – and how that protection changes during different life stages, like menopause. The National Heart, Lung, and Blood Institute (NHLBI) has launched several initiatives focused on understanding sex differences in cardiovascular disease, including the Women’s Heart Health Initiative.
Implications for Diagnosis and Treatment
The study’s findings have important implications for how doctors diagnose and treat women with suspected heart disease. A more nuanced approach is needed, one that considers the full spectrum of symptoms, incorporates advanced imaging techniques, and assesses a wider range of risk factors.
“We need to move away from a ‘one-size-fits-all’ approach to heart disease,” says Dr. Bairey-Merz. “Women need to be evaluated thoroughly, and their symptoms taken seriously. We also need to invest in research to better understand the unique aspects of heart disease in women and develop more targeted therapies.”
For patients, being proactive about heart health is essential. Knowing your family history, maintaining a healthy lifestyle (including diet and exercise), and promptly reporting any concerning symptoms to your doctor are all crucial steps. Don’t dismiss atypical symptoms as “just stress” or “indigestion.”
The study highlights a critical gap in our understanding of cardiovascular disease and underscores the urgent need for continued research and improved clinical practices to ensure that women receive the best possible care. The next major step will be larger, more comprehensive studies that incorporate these alternative risk markers and evaluate the effectiveness of different diagnostic and treatment strategies tailored to women’s specific needs.
Have you or a loved one experienced challenges in getting a heart disease diagnosis? Share your story in the comments below, and please share this article to raise awareness about the importance of recognizing heart disease in women.
