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Women, men with suspected heart disease have similar symptoms

Chest pain and shortness of breath are the most common symptoms reported by both women and men with suspected heart disease, a finding that is in contrast to prior data, according to a study scheduled for presentation at the American College of Cardiology’s 65th Annual Scientific Session.

The study, which includes one of the largest cohorts of women ever enrolled in a heart disease study, also found that women had a greater number of risk factors for heart disease than men, yet these women were more likely to be characterized as lower risk not only by their health care providers, but also by scores that objectively measure and predict heart disease risk.

“The most important take-home message for women from this study is that their risk factors for heart disease are different from men’s, but in most cases symptoms of possible blockages in the heart’s arteries are the same as those seen in men,” said Kshipra Hemal of the Duke Clinical Research Institute in Durham, North Carolina, and lead author of the study.

The finding that women have more risk factors for heart disease than men means measures to reduce risk need to be a priority for women, as well as men, Hemal said.

Some previous studies have suggested that women having a heart attack are less likely to have classic symptoms such as chest pain and more likely to have atypical symptoms such as back pain, abdominal pain and fatigue that may be less readily recognized as heart attack symptoms. Hemal and her colleagues sought to shed light on a different group of patients – those without a prior heart disease diagnosis who were being evaluated for symptoms suggestive of heart disease. Few studies, mostly several decades old, have examined sex differences in this group of patients.

The Prospective Multicenter Imaging Study for Evaluation of Chest Pain (PROMISE), a randomized trial conducted at 193 centers in the United States and Canada, enrolled 10,003 patients, of whom more than 5,200 were women. Half of the patients were randomly selected to receive a heart CT scan, which generates 3-D images of the heart’s arteries that doctors can use to noninvasively assess the degree of narrowing. The rest received a functional or stress test – an exercise electrocardiogram, stress echocardiography or nuclear stress test – used to track the heart’s response to stress. Hemal and her colleagues examined patient data to assess differences between women and men in age, race or ethnicity, risk factors, symptoms, evaluation and test results.