Perhaps the most frightening fact about heart disease is that it can inflict a lot of damage before its victims become aware that there's a problem. High blood pressure, which taxes the blood vessels and stiffens the heart muscles, is famously known as the silent killer. Often, a heart attack can be the first indication that anything is wrong with someone's cardiovascular system. Worse still, heart disease can fool even doctors, especially when it comes to diagnosing the cause of chest pain in women.

Two illnesses that target women in particular—coronary microvascular disease and endothelial dysfunction—often elude standard tests for coronary artery disease (CAD). And according to a study published in the May 11 issue of the Archives of Internal Medicine, women who suffer from chest pain that is difficult to pinpoint by the traditional methods stand a greater risk of suffering a heart attack or stroke.[1]

The Study

The physicians involved in the study, which compared data from the Women's Ischemia Syndrome Evaluation (WISE) study to that from the Women Take Heart Project, suggest that women who experience chest pain but have been told that the typical CAD screenings have turned up nothing of clinical significance should ask their doctors to check for endothelial dysfunction or microvascular disease. Procedures such as acetylcholine endothelial function and adenosine coronary flow reserve tests, carotid duplex ultrasound and pulse wave velocity can better detect whether the chest pain is brought about due to insufficient blood flow caused by either disease.

A Duke Activity Status Index questionnaire, which measures a person's ability to perform day-to-day activities, can also help doctors determine what type of cardiac stress test to perform; unlike the signs of CAD, which can emerge following great physical exertion, chest pain associated with microvascular disease often surfaces after performing routine chores.

Stay on Top

The best thing you can do to ensure that any cardiovascular problems you may have are detected in their earliest stages is to stay on top of your heart health.

  • Have your physician check your blood pressure and do a full blood workup at least once every two years.

  • Familiarize yourself with the following risk factors: family history, smoking, obesity, lack of physical activity, age, diabetes, high LDL and low HDL levels, and high blood pressure. Meeting any four of these criteria is cause for concern.

  • Also, microvascular disease may also be linked to anemia and low estrogen levels, so if you have suffered from either condition, alert your physician or cardiologist to this fact.

[1] Martha Gulati et al, Adverse Cardiovascular Outcomes in Women With Nonobstructive Coronary Artery Disease: A Report From the Women's Ischemia Syndrome Evaluation Study and the St James Women Take Heart Project, Arch Intern Med, May 2009; 169: 843-850; link