Women with angina (chest pain) and normal-appearing heart arteries seem to fare worse than men with similar findings, according to research conducted in Canada.

“Our results suggest that coronary artery disease in women is different than coronary artery disease in men and may require sex-specific tests to diagnose coronary artery disease,” Dr. Karin H. Humphries from the University of British Columbia, Vancouver, told Reuters Health.

Among 32,856 patients having a diagnostic test called cardiac catheterization for symptoms suggestive of ischemia (reduced blood flow to the heart), the researchers found that significantly more women (23.3 percent) than men (7.1 percent) had normal-looking coronary arteries.

Humphries and colleagues also noticed that women with normal-looking arteries were older and more likely to have high blood pressure, a history of stroke, the lung disease COPD, and clogged leg arteries (also called peripheral vascular disease), compared with men with normal heart arteries.

Moreover, far more women than men (30 versus 7) required re-admission to the hospital for chest pain or acute coronary syndrome (ACS) within 6 months of catheterization. ACS is an umbrella term for heart problems caused by reduced blood flow to the heart.

After adjustment for other prognostic factors, women with chest pain and normal-looking coronary arteries were 4 times more likely than similar men to require rehospitalization for ACS within 6 months of discharge from the initial cardiac catheterization procedure.

With cardiac catheterization, a thin tube or catheter is snaked into the heart arteries and a contrast dye is released. A series of x-rays taken as the dye works its way through the vessels shows where arteries are blocked.

While cardiac catheterization “may be the gold standard test of coronary disease in men, in women it may be more important to focus on the clinical presentation and treat them as if they had CAD, i.e., treat with beta blockers and aspirin,” Humphries said. “Also,” she added, “other diagnostic tests should be explored in women.”

SOURCE: American Heart Journal, February 2008.