Women Carry Heavier Burden of Chest Pain, But Less Artery Narrowing

Women with coronary artery disease that causes ischemia have significantly more chest pain, yet less extensive disease compared to men, according to new research presented at the American College of Cardiology’s Annual Scientific Session Together with World Congress of Cardiology (ACC.20/WCC).

The study looked at 4,011 men and 1,168 women with stress test results indicative of moderate to severe ischemia and was the first to look at sex differences within this patient population. Exclusion criteria was defined as any patients with open arteries, or no obstructive coronary artery disease, on further testing. The researchers noted that because women were more than three times as likely as men to have non-obstructive disease (34% vs. 11%), they only comprised 23% of study participants.

According to the results, women had a 38% higher odds of having more chest pain than men, even after factoring for such age, race, stress test findings, medication use, smoking, diabetes, high blood pressure, prior heart attack, kidney function and overall heart function. “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, MD, director of the Sarah Ross Soter Center for Women’s Cardiovascular Disease at NYU Langone Health and the study’s lead author in a press release.

“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,” Dr. Reynolds added. “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.”

Reynolds H. Sex Differences in Stress Test and CCTA Findings and Symptoms in the Randomized Ischemia Trial. Presented at the ACC.20 World Congress of Cardiology; March 28-30, Chicago, IL.