Angina 'may be missed in women'
BBC
Mon March 20, 2006
Women with chest pains may be dying of heart disease unnecessarily because doctors under-estimate the severity of their condition, research suggests.
A team from University College London found that angina - often the first sign of heart disease - affected women at the same rate as men.
However, women with suspected angina were less likely to be offered confirmatory diagnostic tests.
The study appears in the Journal of the American Medical Association.
The UCL team say their work suggests that medics must be much more ready to carry out full investigations when they are consulted by women complaining of chest pains.
Approximately 2 million people in the UK suffer from angina, a pain or discomfort in the chest caused by lack of oxygen to the heart muscle.
It is the result of a furring up of the arteries beginning to restrict blood supply.
The pains can often be brought on by exercise, or sudden physical activity.
Research suggests that around 60% of people who survive a heart attack previously experience angina pains.
The UCL team studied the records of over 100,000 angina patients aged 45-89 years.
They found that each year, two women out of every 100 in the general population developed angina, as the first sign of heart disease.
No tests
The study found that women diagnosed with angina were less likely to be given follow-up tests to confirm their condition, such as angiograms or treadmill exercise electrocardiograms (ECGs).
Without these tests patients do not qualify for surgical treatments, such as bypass operations.
These women were found to be significantly more likely to go on to die from heart disease.
However, the researchers report that such women have often been dismissed as having a 'soft' subjective complaint, without real pathological changes in the heart.
Researcher Professor Harry Hemingway said: "For women, angina is a more significant public health problem than many doctors, or indeed the general public, realise.
"Women develop angina at a similarly high rate as men. And the angina which women experience is not benign in terms of death rates.
"We need to understand why women are relatively protected from heart attack but not from angina, and ensure fair access to investigation and treatment services."
Pre-menopause protection
Professor Hemingway said it could be difficult to establish categorically which patients have angina.
And because many patients with the condition do not require hospital treatment, the issue had not been given the focus it deserved.
"The opposite is true for heart attacks, where nearly all patients are tested to confirm the diagnosis and are admitted as an emergency into hospital."
He said the study also uncovered evidence that even when women were sent for ECG tests, the scans sometimes failed to pick up abnormalities.
Professor Peter Weissberg, medical director at the British Heart Foundation which funded the study, said: "As women tend to be protected from angina until after the menopause, it has traditionally been thought of as a predominantly male affliction.
"This study confirms that after the age of 45 years women get as much angina as men but worryingly, they tend to fare worse than men when they get it.
"This study reinforces our view that women with angina should receive prompt and appropriate treatment to reduce their risk of suffering a heart attack."
A Department of Health spokesperson said the government was committed to cutting premature deaths from coronary heart disease by 2010.
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