Independent The Magazine | Winter 2009 Edition

ASHLAND  Coronary Heart Disease is among the leading cause of death among American men and women, but women are more likely to die from the disease than their male counterparts because of disparities in research, diagnosis and treatment between the genders.

“There has just been a research lag,” said cardiologist Robert Touchon, director of the Kentucky Heart Institute at Kings Daughters Medical Center. For years, doctors, the media researchers and others “just didn’t pay attention,” he said. After decades of higher mortality rates and less successful open heart surgeries, leading women researchers — including several from the area — began to aggressively pursue the issue.

In 1996, The National Institute of Health began the Women’s Ischemia Syndrome Evaluation, or WISE study, which was aimed at catching up and answering several key questions about the disease in women.

The study was conducted at four medical centers across the U.S. and followed 936 women over six years. It was aimed at getting a better understanding at how ischemia heart disease develops in women and to evaluate the influence of hormones on the disease’s development and the role it plays in diagnosing the disease.

To put it simply, what they found, Touchon says, “is boys and girls are different. They (women) present later in the course of the disease, they present in older patients and they present with different signs and symptoms.

The classic example of the 50-year-old man that goes out to shovel snow gets severe chest pain, collapses, is taken to the hospital and then is having a heart attack is a very unlikely presentation in a women. A woman tends to present with some nausea, some vague pains, maybe some right arm pains a feeling of dizziness a shortness of breath. (She) goes to the hospital and might be having a cardiac event every bit as serious as the dramatic collapse and the ambulances and the red lights but it’s a different manifestation,” Touchon explained. “So, we need to treat coronary heart disease a bit differently and recognize it a bit differently in gender specific manifestations.”

The WISE study found the biggest difference in the presentation of the disease between men and women, and the reason it is often misdiagnosed in women, is they tend to develop a condition called coronary microvascular syndrome, according to Touchon.

In coronary microvascular syndrome, plaque accumulates in very small internal arteries of the heart. It also causes narrowing, reduced oxygen flow to the heart and pain that is similar to that which occurs when larger arteries become blocked, which is more typical in men, he said, but is harder to find. The blockages often do not show up when physicians use standard tests, such as heart catheterization, and as a result many women go undiagnosed.

“We have the technology for that (detecting blockages in the small arteries) but its not generally available,” according to Touchon. “The treatment is still not as apparent to make that worthwhile,” he said. “Our doctors in Ashland are using a lot of it now but it still has not become standard care.”

That may soon change and KHI and KDMC are at the forefront of collecting evidence to support those changes, Touchon said. The pharmaceutical company, which has developed a medication to treat the small vessel blockages, is funding a study to research the effects of its drug and to address the other obstacle that makes the disease so deadly — accurately recognizing its symptoms.

Based on the results of the WISE study, a women-specific questionnaire was developed to help doctors recognize the common symptoms of heart disease in women but is still being refined.

Beginning in March, KHI —in conjunction with 25 other medical centers in the U.S. — will begin a research study aimed at testing the reliability, validity and responsiveness of that questionnaire as well as evaluating the effectiveness and outcome of the newly developed medication.

According to Touchon, approximately 25 women will participate in the study at KHI for approximately one month each. “The purpose is to develop an instrument, a way to evaluate chest pain in women. We hope that it will separate men from women. There is obviously going to be some overlap,” he said.

The Tri-State is the perfect location for the study, in part because of the large population with, or at risk of developing the disease, according to Touchon. Appalachian residents have a greater risk of developing and dying from the disease than any other population in the country.

Even with the advancing research about treatment and detection of the disease, Touchon said, doctors must continue to raise awareness and educate women about the disease. Women are less likely to go to the hospital when they have pains, meaning it is less often caught in the early stages. He speculates this is because “women are taught culturally, that life hurts. It hurts to have menstrual cramps, it hurts to have a baby, it hurts to work, you get aches and pains, — get over it.”

Often times pain associated with coronary heart disease in women “is such a non-specific pain or it’s not necessarily a new pain,” according to Touchon. His advice? Talk to your doctor and pay attention to and take care of your body.

Heart Disease Q & A

How many women live with the disease?

The National Coalition for Women with Heart Disease estimates there are 8 million American women living with heart disease. Another 36 million American women are at risk of developing heart disease. A 2004 study by the National Coalition for Women with Heart Disease found that more than 142,000 women over the age of 45 that had been diagnosed with the disease in Kentucky.

Is heart disease deadly?

The leading cause of death among women in the U.S. is heart disease. According to the National Coalition for Women with Heart Disease, approximately one third of all female deaths each year are from heart disease. Of the 500,000 annual female deaths from heart disease, more than half die from heart attacks.

Who is at risk of developing heart disease?

Several key risk factors have been linked to heart disease including heredity and age. Women over the age of 55 and those who have gone through menopause or who have had a hysterectomy are twice as likely to develop heart disease, in part because their body’s production of estrogen drops.

Can I prevent the disease?

• Smoking,
• High blood cholesterol
• High blood pressure
• Physical inactivity,
• Obesity
• Being overweight
• Diabetes
• Stress
• Consuming too much alcohol

All these can be contributing factors to ones risk of developing heart disease. Although certain risk factors cannot be modified, others can not. more risk factors an individual has, the greater their risk of heart disease. Talk to your doctor about your risk factors.

What are the early warning signs I might have heart disease?

Angina, or heart muscle pain, accompanied by shortness of breath or indigestion is the first warning sign of blocked arteries. The pain is a result of the heart not getting enough oxygen because not enough blood and oxygen can get to the heart through the arteries. If untreated, angina can lead to a heart attack.

Do you know the symptoms of a heart attack?

• Discomfort, tightness, uncomfortable pressure, fullness, squeezing in the center of the chest lasting more than a few minutes, or comes and goes
• Crushing chest pain
• Pressure or pain that in the back, shoulders, neck, upper back, jaw, or arms.
• Dizziness or nausea; breaking out in a cold sweat
• Clammy sweats, heart flutters, or paleness
•  Unexplained feelings of anxiety, fatigue or weakness – especially with exertion
•  Stomach or abdominal pain
• Shortness of breath and difficulty breathing

What should I do if I think I’m having a heart attack?

• Listen to your body if you begin to have symptoms that are abnormal for you don’t ignore them. Most heart attacks start with mild pain and discomfort.
• Call 911 immediately. Response time is critical. The longer you wait to get medical attention the greater your risk of dying and more severe damage to your heart can occur.
• Tell the paramedics and/or emergency room doctors all your symptoms; stressing that what you are experiencing is not normal to you.
• At the hospital, don’t let anyone tell you that your symptoms are “just indigestion” or that you’re overreacting. You have the right to be thoroughly examined for a possible heart attack. If you are having a heart attack, you have the right to immediate treatment to help stop the attack.
• Ask for tests that can determine if you are having a heart attack. Commonly given tests include an electrocardiogram (EKG or ECG), a cardiac enzyme blood test, a nuclear scan, and a coronary angiogram (or arteriogram).