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Heart Health, Explained

Ischemia: Gender-Specific Research Improving Coronary Heart Disease Diagnoses in Women

For many years, health care providers used a male model of coronary heart disease testing to identify the disease in women, focusing on the detection of obstructive artery disease. However, women with heart disease are more likely than men to develop dysfunctions of the smaller coronary arteries and the lining of the coronary arteries, often not detected through the male-model testing. As a result, symptomatic women were not diagnosed with coronary heart disease and did not receive appropriate treatment, increasing their risk of heart attack. Recently, however, gender-specific research that clarifies these differences has made diagnosing coronary heart disease in women more accurate, according to a new scientific statement published in the American Heart Association journal Circulation and publicized in a June 16, 2014 press release.

Ischemia in Women Q&A

Q: What is coronary heart disease or ischemic heart disease?

A: Ischemic Heart Disease occurs when there is a lack of blood supply to the heart which is either temporary (angina), occurring only with stress, or permanent, resulting in a heart attack. When one or more of the coronary arteries of the heart are blocked, the blood supply becomes endangered and ischemia (deficient supply of blood to the heart) occurs. This blockage occurs over many years. The precursors of blockage, called fatty streaks, are present in the coronary arteries of many individuals under the age of 20.

Q: How does this condition lead to increased risk of heart attack, and are there gender differences?

A: Over time, fat (lipid) and smooth muscle cells proliferate, building a lump called an atheroma. This lump eventually encroaches into the middle (lumen) of the artery through which blood flows. Some of these lumps develop a firm cap and are stable; if these atheroma are big enough, ischemia may develop when there is increased blood flow such as during exercise. Other, very dangerous atheroma have a very thin cap that can tear and attract a clot to that segment of the artery. The clot or thrombus completely occludes the artery, causing an acute loss of blood flow to that area of the heart resulting in a heart attack. An important difference between men and women is that women may have disease of the microvasculature, or very small branch vessels. This type of disease does not show up on common cardiac tests such as heart catheterization, and may be extremely difficult to diagnose and frequently overlooked.

Q: What are the differences between women and men in the signs and symptoms of coronary heart disease? What range and patterns of symptoms might women experience compared to men?

A: It is imperative to realize that heart disease remains the number one killer of both women and men so one must have a high level of concern when unusual symptoms occur, keeping in mind that prompt medical attention can save lives. The most common symptom for both sexes is chest discomfort, occurring in 80 to 90 percent of patients. However, women are more likely to have fatigue, shortness of breath, back pain, indigestion and weakness when compared to men. Women also are more likely than men to have discomfort in the upper abdomen, throat, neck and jaw. For both men and women the pain is usually not sharp, but more frequently a feeling of pressure or tightness. Whereas men usually will have cardiac symptoms when exerting themselves, women may more typically suffer them during emotional stress or at rest.

Q: What should a woman do if she experiences any of these signs or symptoms?

A: If there are sudden symptoms of chest, arm, jaw, neck or back pain, or weakness, indigestion, shortness of breath, lightheadedness/passing out or sweating sensation, and these sensations do not go away quickly the best approach is to call 911. Delaying going to the hospital or driving one’s self to the hospital is extremely dangerous and can be lethal. The more time that passes before a heart attack is treated, the more chance of severe disability or death – so rapid medical attention is imperative.

Q: How can the risks of heart disease, stroke and heart attack be reduced?

A: The risk factors for arterial vascular disease leading to heart attack and stroke are well known, and most are preventable. Tobacco or nicotine use in any form is a major risk factor for coronary heart disease, stroke and peripheral vascular disease. Ingesting any amount of tobacco, including by secondhand smoke exposure, raises these risks. Smokers have double to four times the risk for heart disease than nonsmokers. The risk of coronary heart disease is 25% higher for women who smoke compared with men who smoke. In fact, smoking bans have been shown to significantly reduce heart attack deaths. Being overweight and inactive are major risk factors that contribute to other important risk factors for hypertension or high blood pressure, diabetes and high cholesterol. The American Heart Association recommends 30 minutes per day of moderate physical activity at least five days a week. This link provides useful information about eating healthy for weight control and heart disease prevention. Cholesterol, blood pressure and diabetes management can be achieved working with one’s primary care provider. Making these lifestyle changes will substantially reduce the risk of a fatal or disabling heart attack or stroke.


Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

Mary Alton, MD, FACC North Region Medical Director, Non-invasive Imaging OhioHealth Healthcare System, Columbus, Ohio

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.