Harvard Heart Letter

Beyond the bulge: A new look at heart disease in women

Heart disease with arteries that appear to be free of cholesterol-filled bulges isn't a contradiction in terms. Up to 3 million American women — and some men — may have this "new" form of heart disease.

If a "standard approach" to identifying and diagnosing heart disease exists, it goes something like this: You notice pain or tightness in your chest when climbing stairs or lugging groceries into the house. Your doctor sends you for an exercise stress test. As you walk on the treadmill, the electrocardiogram shows that part of your heart isn't getting enough oxygenated blood. Next stop: angiography. This special x-ray shows that cholesterol-filled plaque has narrowed one of your coronary arteries by 75% or more. Treatment follows.

This sequence, it turns out, doesn't work nearly as well in women who have chest pain, shortness of breath, unusual fatigue, or other signs of reduced blood flow to part of the heart as it does in men. Many women don't have the strength or endurance to complete an exercise stress test. And a whopping half or more of women who have alarming stress tests have what look to be clear coronary arteries on an angiogram.

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