ISCHEMIA: Angina more frequent in women vs. men despite less CAD, ischemia
Despite having less ischemia and less extensive CAD compared with men, women had more frequent angina, according to new data from the ISCHEMIA trial.
The researchers analyzed sex differences in ischemia, coronary anatomy and symptoms among patients with stable ischemic heart disease enrolled in ISCHEMIA. All patients underwent stress testing before enrollment and coronary CTA to confirm obstructive CAD after enrollment and before randomization.
“Women are having more chest pain, even though they have less plaque on imaging, and yet they have very abnormal stress test results,” Harmony R. Reynolds, MD, associate professor of medicine, associate director of the Cardiovascular Clinical Research Center and director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health, said in a press release.
Women were more likely than men to be excluded after enrollment because coronary CTA found no obstructive CAD, defined as less than 50% stenosis in all vessels (34% vs. 11%; P < .001), according to the researchers.
However, the 1,168 women who underwent randomization had more frequent angina than the 4,011 men who underwent randomization (P < .001), despite less extensive CAD on coronary CTA (P < .001) and less severe ischemia on stress testing (P = .006), Reynolds and colleagues found.
“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 in the release. “These findings suggest that even though there may not be as much plaque, many women may have chest pain that limits their daily activities. We have medicines that can improve chest pain from heart disease. 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?” – by Erik Swain
Reynolds HR, et al. Abstract 1072-03. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Disclosure: Reynolds reports she has received donated products for research from Abbott and BioTel.