A coronary heart disease, known as coronary microvascular syndrome,is haunting as many as 3 million U.S. women. However, its diagnosis is not easy, according to new research from the National Institutes of Health (NIH).

The study says the standard test, called diagnostic coronary angiography, could not detect the condition because cholesterol plaque may not build up into major blockages, but instead spreads evenly throughout the artery wall. This results in clear arteries in angiogram, often leading to a false negative diagnosis.

Coronary microvascular syndrome is a condition in which plaque accumulates in small arteries of the heart, causing narrowing, reduced oxygen flow to the heart. As a result, women with the heart disease feel fatigued and short of breath, but do not feel as much pain as men.

The study titled Women's Ischemia Syndrome Evaluation (WISE), by the National Heart, Lung, and Blood Institute's (NHLBI), followed 1,000 women for five years. The results were published in a special supplement to the Feb. 6 issue of the Journal of the American College of Cardiology, available online Jan. 31.

"When a diagnosis of this condition is missed, women are not treated for their angina and high cholesterol and they remain at high risk for having a heart attack," said NHLBI Director Elizabeth G. Nabel, M.D.

"This study and the high prevalence of coronary microvascular dysfunction demonstrate that we must think out of the box when it comes to the evaluation and diagnosis of heart disease in women."

The WISE study, beginning in 1996, was intended to increase scientific knowledge about ischemic heart disease in women. Specifically, the study was meant to develop accurate diagnostic approaches for ischemic heart disease detection in women, to better understand the ways in which heart disease develops in women (including the significance of ischemia without coronary blockages in women), and to evaluate the influence of hormones on ischemic heart disease development and diagnosis.

"So much of our understanding of the underpinnings of heart disease and heart attack, and the basis for our standard methods of diagnosis and treatment are the result of research conducted on men," said C. Noel Bairey Merz, Cedars-Sinai Medical Center and the WISE study chairperson.

"Through clinical experience, many critical questions arose about how the disease may manifest differently in women, and how diagnostic techniques may need to be used differently in order to prevent more heart attacks and save lives."

The majority of women with "clear" angiography who are not diagnosed will continue to have symptoms, declining quality of life, and repeated hospitalizations and tests, according to the investigators.

"Through WISE, we have made tremendous progress toward better understanding of heart disease in women. Too often women are tested again and again, go untreated, and still have high risk for heart attacks," said George Sopko, MD, NHLBI project officer for WISE.

"As clinicians we must systematically examine women for evidence of any blockages and initiate intensive treatment for their risk factors."

The WISE study delivers a message that coronary microvascular syndrome in women is hard to detect and physicians should exercise caution when it comes to diagnosis. Those diagnostic methods that work well in men will likely fail to work in women.

Heart disease, which can affect females at all ages, is the number one killer of women, killing one in three American women. Coronary heart disease is the most common form of heart disease, which develops over time and can start as early as the teenage years.

More than 10 million American women have heart disease. One in 14 women aged 45 to 64 and one in six women aged over 65 suffer coronary heart disease.

According to the Department of Health and Human Service, making lifestyle changes is needed to lower the risk of heart disease in women. For young women, physical activity levels, overweight and use of tobacco may raise the risk. For older women, age also may play a role.

Important risk factors for heart disease include high blood pressure, high cholesterol, diabetes, smoking, being overweight, physical inactivity, family history and age.

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