Although women seeing a physician for the first time with suspected heart disease experience the same classic symptoms as men — like chest pain and shortness of breath — differences between the sexes in the diagnosis and risk assessment processes are evident, according to a new study in JACC Cardiovascular Imaging.
To determine whether presentation, risk assessment, testing choices and results differ between the sexes, researchers compared the characteristics of 10,003 men and women in the Prospective Multicenter Imaging Study for Evaluation of Chest Pain, or PROMISE, trial.
Here are five findings from the study.
1. Chest pain was the primary symptom in both sexes — 73.2 percent of women and 72.3 percent of men. The feeling was described as "crushing/pressure/squeezing/tightness" in 52.5 percent of women versus 46.2 percent of men.
2. That said, women were older (62.4 years of age versus 59 years of age) and were more likely to be hypertensive (66.6 percent versus 63.2 percent), dyslipidemic (68.9 percent versus 66.3 percent) and have a family history of premature coronary artery disease (34.6 percent versus 29.3 percent) than men.
3. Women were less likely to smoke than men (45.6 percent versus 57 percent), but they experienced similar rates of diabetes (21.8 percent versus 21 percent).
4. Compared with men, all risk scores characterized women as being at lower risk for CAD, and providers were more likely to characterize women as having a low pre-test probability of CAD (40.7 percent versus 34.1 percent).
5. Even though women were referred to imaging tests more often than nonimaging tests, they were less likely than men to have a positive test (9.7 percent versus 15.1 percent).
"Patient sex influences the entire diagnostic pathway for possible CAD, from baseline risk factors and presentation to noninvasive test outcomes," concluded the study. "These differences highlight the need for sex-specific approaches for the evaluation of CAD."
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