Reconstructing Angina: Cardiac Symptoms Are the Same in Women and Men

Study Questions:

Do symptoms related to coronary artery disease (CAD) differ by gender?

Methods:

Patients with suspected CAD and/or angina were included in this analysis. Additional inclusion criteria were at least one prior abnormal cardiac test result, and no prior coronary angiograms. Enrollment occurred from June through November 2010. A standardized cardiac assessment tool, previously validated, was used to capture patients’ risk factors and symptoms. An experienced angiographer blinded to patient identifiers interpreted the angiographic findings. Obstructive CAD was defined as the presence of at least one vessel 2.0 mm or larger in diameter with at least 70% stenosis. Baseline characteristics including age, cardiac risk factors, and coronary anatomy were compared between women and men. Symptoms were analyzed according to sex/gender and obstructive CAD angiographic results.

Results:

A total of 128 men and 109 women were included in this analysis. Traditional risk factors were present in 118 participants (50% of the sample). Women were slightly older (mean age, 67.5 vs. 64.5 years; p = 0.06), more likely to have normal coronary arteries (22 of 109 [20%] vs. 10 of 128 [8%]; p = 0.004), and less likely to have obstructive CAD (50 of 109 [46%] vs. 89 of 128 [70%]; p < 0.001) when compared with men. Men were more likely to be past smokers (60% vs. 41%, p < 0.001). In terms of symptoms, the most common descriptors used by men and women with obstructive CAD included “chest pain” (82% vs. 84%, p = 0.72), “pressure” (54% vs. 58%, p = 0.65), and “tightness” (43% vs. 58%, p = 0.08), respectively. Women used certain descriptions approximately twice as often as men, including “discomfort” (46% vs. 28%, p = 0.03), “crushing” (24% vs. 9%, p = 0.02), “pressing” (28% vs. 14%, p = 0.04), and “bad ache” (30% vs. 15%, p = 0.04). Men and women reported pain in the same areas outside the chest region, including the arms (43% vs. 50%, p = 0.40), back (26% vs. 30%, p = 0.65), and shoulders (32% vs. 26%, p = 0.45), respectively. Other symptoms reported by men and women included shortness of breath (67% vs. 76%, p = 0.25), fatigue (56% vs. 62%, p = 0.52), sweating (48% vs. 46%, p = 0.80), and weakness (32% vs. 46%, p = 0.11), respectively. Women were more likely to report dry mouth (34% vs. 18%, p = 0.04), whereas men did not report any symptoms significantly more often than women.

Conclusions:

The investigators concluded that many cardiac symptoms are similar for men and women with obstructive CAD. This information can help clinicians to better contextualize symptoms associated with obstructive CAD, rather than adhering to the conventional “typical” and “atypical” angina distinction.

Perspective:

Prior studies have generally shown that women are more likely to have atypical cardiac symptoms; however, as with this present study, a small number of prior studies have observed similar rates of more ‘classic’ chest pain equally among men and women. Differences in results likely relate to several factors including types of patients accessed (acute coronary syndrome vs. patient’s schedule for elective angiograms), recall biases, and difference in survey instruments used to assess symptoms. While these data suggest that women should understand that the classic symptoms pertain to them and should not be ignored, as the authors suggest, further research in larger, more diverse populations is recommended. In addition, understanding symptoms in the context of cardiovascular risk factors would assist in the identification of both men and women most likely to have significant disease.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Atherosclerotic Disease (CAD/PAD), Sleep Apnea

Keywords: Mouth, Coronary Artery Disease, Women, Acute Coronary Syndrome, Sweating, Fatigue, Coronary Disease, Dyspnea, Mental Recall, Men, Chest Pain, Cardiology, Cardiovascular Diseases


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