News | Womens Cardiovascular Health | March 28, 2020

Sex Differences in Stress Test and CCTA Findings and Symptoms in the Ischemia Trial

Women carry heavier burden of chest pain, but less artery narrowing

Find more news from ACC 2020.Women carry heavier burden of chest pain, but less artery narrowing according to data in a substudy of the ISCHEMIA Trial. #ACC20 #ACC2020 #ISCHEMIA

Women carry heavier burden of chest pain, but less artery narrowing, according to data in a substudy from the ISCHEMIA Trial. 
 

March 28, 2020 — Women with coronary artery disease that reduces blood flow and oxygen to the heart muscle (ischemia) have significantly more chest pain caused by plaque build-up, yet less extensive disease as compared with men, according to new research presented at the American College of Cardiology (ACC) 2020 conference, being presented virtually onlinwe this year due to the COVID-19 pandemic.

The study, which included a subset of women and men from the ISCHEMIA Trial who received abnormal stress test results indicative of moderate to severe ischemia, is the first to look at sex differences within this patient population. Those with open arteries, or no obstructive coronary artery disease, on further testing were excluded from this analysis. Because women were more than three times as likely as men to have non-obstructive disease (34 vs. 11 percent), women only comprised 23 percent of study participants, with 4,011 men and 1,168 women ultimately being enrolled. Women in the study had 38 percent higher odds of having more chest pain than men, even after considering other factors such as age, race, stress test findings, medication use, smoking, diabetes, high blood pressure, prior heart attack, kidney function and
overall heart function.

Harmony Reynolds, M.D., director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health and the ISCHEMIA trial substudy lead author. #ACC20 #ACC2020“Women are having more chest pain even though they have less plaque on imaging, and yet they have very abnormal stress test results,” said Harmony Reynolds, M.D., director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health and the study’s lead author. She said the results beg the question of why and what might be different about the biology of how plaque forms in men and women, especially as more severe angina is typically associated with higher rates of events like heart attack or death.

“The heart has nerves that can sense when there isn’t enough blood flow, but we can’t always tell if those nerves have been activated by a large amount of heart muscle or a smaller amount,” Reynolds explained. “Just like a small cut on your finger can really sting and hurt and yet it may hardly look like anything. So when it comes to the burden of chest pain in these women, is it because the activation of nerve endings in a relatively smaller amount of heart muscle will raise the red flag in a woman’s brain differently, or is it because there are other factors going on in women, like small vessel disease, that we aren’t assessing with the tests that we are using?”

The results underscore the need for more research and for clinicians to adopt a dual focus to prevent cardiovascular events and worsening disease, as well as to better control symptoms to improve patients’ quality of life.

For this study, patients from the ISCHEMIA trial were included based on very abnormal stress test findings and presence of some degree of narrowed coronary arteries. Women were found to have less ischemia on stress tests than men even though they had more angina. Those tests included stress nuclear tests, stress echocardiograms and stress MRI tests. Chest pain symptoms were assessed using the validated Seattle Angina Questionnaire, which asked questions about how often patients experience chest pain and whether it affects daily activities, such as walking briskly, lifting, cooking, vacuuming, bathing and more.

“Even when women have very abnormal stress tests — more characteristic of what we think of as typical ‘male type’ coronary heart disease — they have less extensive atherosclerosis and yet they are still having more symptoms as compared to men,” Reynolds said. “These findings suggest that just because there may not be as much plaque, many women may have chest pain that limits their daily activities, and we have medicines that can improve chest pain from heart disease.”

This analysis is limited in that it only includes people with very abnormal stress tests. In addition, people whose symptoms were uncontrollable with medication could not be enrolled in the study.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health. 

Read more on this study from AHA 2019 — ISCHEMIA Trial Results Find Interventions for Stable Heart Disease No better Than Drug Therapy

Find more news from ACC 2020.

 

Related Women's Cardiovascular Health Content

VIDEO: Differences in Cardiac Complications and Presentation Between Men and Women

Women With Coronary Artery Wall Thickness at Risk for Heart Disease

Diagnostic Differences in Women’s Heart Health

VIDEO: Gender Differences in Diagnosing Heart Disease in Women

VIDEO: Use of Cardiac MRI in Congenital and Women's Heart Disease — Interview with Karen Ordovas, M.D.

Find more women's cardiovascular news

 

Related Content

Some of the top technology news from ACC 2021. Top left, the LAAOS III trial showed benefit when surgeons seal off the LAA during other open heart procedures. Bottom left, the ReCor Paradise renal denervation system helped lower blood pressure in patients who did not respond to medication. Top right, for patients with both heart failure and AFib it makes no differences is therapy is focused on controlling the heart rhythm or heart rate. Bottom right, the FLOWER-MI trial found no benefit to FFR-guided PCI.

Some of the top technology news from ACC 2021. Top left, the LAAOS III trial showed benefit when surgeons seal off the LAA during other open heart procedures. Bottom left, the ReCor Paradise renal denervation system helped lower blood pressure in patients who did not respond to medication. Top right, for patients with both heart failure and AFib it makes no difference if therapy is focused on controlling the heart rhythm or heart rate. Bottom right, the FLOWER-MI trial found no benefit to FFR-guided PCI in STEMI with multi-vessel disease.

Feature | ACC | June 08, 2021 | By Dave Fornell, Editor
Here are the top 10 takeaways from the late-breaking studies on cardiovascular technologies presented at the 2021 ...
AMERICAN COLLEGE OF CARDIOLOGY (ACC) Late-breaking clinical trial study presentations at ACC.21. @ACC21 @ACC2021
Feature | ACC | May 18, 2021 | Dave Fornell, Editor
The latest cardiology practice-changing scientific breakthrough, late-breaking study presentations have been announce
To help monitor the health of ACC 2021 in-person attendees for signs of COVID infection, the meeting will use BioIntelliSense's wearable BioButton continuous wireless temperature and vital signs monitoring. The wearable monitor is the size of a coin and is disposable.

To help monitor the health of ACC 2021 in-person attendees for signs of COVID infection, the meeting will use BioIntelliSense's wearable BioButton continuous wireless temperature and vital signs monitoring. The wearable monitor is the size of a coin and is disposable.

News | ACC | February 09, 2021 | By Dave Fornell, Editor
UPDATE Feb 22, 2021 — ...
The American College of Cardiology (ACC) released a list of the latest practice-changing presentations at the ACC.20 annual meeting March 28-30, 2020, in Chicago. This includes five late-breaking clinical trial (LBCT) sessions and three featured clinical research sessions. There also are two LBCT deep-dive sessions where the experts will break down the hottest trials and attendees can find out what the impact might be on the practice of cardiology and patients.
Feature | ACC | April 09, 2020 | Dave Fornell, Editor
Here is the list of American College of Cardiology (ACC) practice-
ACC Cancels 2020 Conference Amid Coronavirus Concerns. #COVID19 #coronavirus #2019nCoV
Feature | ACC | March 09, 2020 | Dave Fornell, Editor
March 9, 2020 — Less than week after the American College of Cardiolog...
American College of Cardiology Names Douglas Drachman Next Annual Scientific Session Vice Chair

Image courtesy of Massachusetts General Hospital

News | ACC | October 08, 2019
Douglas Drachman, M.D., FACC, has been selected as the next vice chair of the American College of Cardiology’s (ACC)...
SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions. FFR in the cath lab.

SyncVision iFR Co-registration from Philips Healthcare maps pressure readings onto angiogram. Results from an international study presented at ACC 2019 indicates pressure readings obtained using iFR (instantaneous wave-free ratio, also referred to as instant wave-free ratio or instant flow reserve) in coronary arteries may localize stenoses that remain after interventions.

Feature | ACC | March 27, 2019 | Greg Freiherr, Contributing Editor
The fingerprints of value-added medicine were all over products and works-in-progress on the exhibit floor of the a

The opening late-breaking trial at ACC 2019 is the Apple Heart Study, a large-scale, app-based study to identify atrial fibrillation using a smartwatch. Earlier, smaller trials showed this approach might be used in a population health application to proactively identify AFib patients earlier.

Feature | ACC | March 19, 2019
The American College of Cardiology (ACC) released a list of the late
A patient who received HeartMate III LVAD system at ACC.18. The HeartMate 3 was the topic of of the the key late-breaking trials at #ACC18

A patient who received the HeartMate III LVAD system showing off his external battery pack. He served as a patient ambassador in the Abbott booth at ACC.18. The HeartMate III, with its magnetic levitated pump, showed a big reduction in clotting over previous LVADs in a key late-breaking trial at this year's conference.

Feature | ACC | March 27, 2018 | Dave Fornell
There were several notable presentations of new data on cardiovascular technologies at the recent 2018 American Colle