Dr Noel Bairey-Merz, Director, Barbra Streisand Women’s Heart Center and Preventive Cardiac Center; Professor of Medicine, Heart Institute, Cedars-Sinai Medical Center and UCLA, USA.

Dr Noel Bairey-Merz speaks with Cardio Debate and Radcliffe Cardiology about diagnosing angina and the key differences between men and women during the ESC Congress 2015 in London, UK

Transcript form the Interview:

What are the key differences regarding angina between men and women?
Women report more angina, if we look at populations, more women will tell you that they have angina, and this is to do with women and men having different somatic awareness. Women feel their bodies sooner, they feel pain more strongly than men and they are more willing to report it.

The other big difference is that women, maybe because of this somatic awareness, are more likely to report atypical symptoms. So within the angina diagnosis, where two-thirds of men will have typical angina, only one third of women will have typical angina. Two thirds therefore will have atypical angina, so atypical angina is more prevalent in women.

Angina with normal coronary arteries is more common in women. Is this a benign condition?
It is not a benign condition, it is associated in our Women’s Ischemia Syndrome Evaluation study – WISE – it is associated with an increase adverse prognosis of major adverse cardiac events similar to one or two vessel obstructive coronary disease.

What are the most important findings of WISE?
Probably the most important findings of the WISE study have been the appropriate diagnosis – so detection, then diagnosis – of coronary microvascular dysfunction, defined as a limited coronary flow reserve to adenosine, or defined as abnormal endothelial function to acetylcholeine. And that this is prevalent in over half of the women with no obstructive coronary disease but signs and symptoms of ischemia have this diagnosis. And then number two, that the prognosis is adverse and comparable to one or two vessel obstructive coronary disease and therefore needing treatment.

What are your key recommendations to general practitioners regarding the diagnosis of angina in women?
Probably the most important recommendation is not to ignore chest discomfort – typical or atypical angina- in women, or men (men increasingly have no obstructive coronary disease, it’s a bit of an epidemic). So number one, don’t ignore it.

Number two, it is a vital sign – that is chest discomfort that is not diagnosed as GERD or gall bladder, or oesophageal spasm, is likely cardiac and should be further investigated. And then referral to a cardiologist if possible, and then diagnosis made.

Or treat. Treat presumptively. Try nitroglycerine, or calcium channel blockers empirically. If there is a good response, again, these are safe and effective drugs. This is not over-treatment for this prevalent condition.