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The Curbsiders: Rethink the Paradigm of Coronary Artery Disease in Women

The Curbsiders podcasters recently interviewed Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center in the Smidt Heart Institute, about rethinking the paradigm of coronary artery disease in women.

The Curbsiders team consists of a national network of medical students and residents as well as clinician educators, representing 15 different medical institutions across the country. On the podcast, the hosts “curbside” the experts to take a deep dive into various topics in the world of healthcare.

The topic for Bairey Merz' guest stint: Coronary artery disease, the narrowing of the main blood vessels that send blood and oxygen to the brain.

At the beginning of the podcast, the Curbsiders team presented a case study and then had Bairey Merz detail each step of evaluation and treatment. The case: a 45-year old woman who was recently hospitalized for shortness of breath and tightness in her chest. Tests taken while admitted in the hospital showed no signs of coronary artery disease and the patient left the hospital without a diagnosis.

“This case exemplifies as simple thinking has become fairly prominent in cardiology,” said Bairey Merz. “That is if the main, large coronary arteries are not obstructed, then there is nothing wrong with you.”

But that thinking is incorrect, Bairey Merz told The Curbsiders. Bairey Merz has studied this type of heart disease -- called Ischemia with No Obstructive Coronary Artery Disease -- for more than 20 years and leads the National Heart, Lung, and Blood Institute's multi-center Women's Ischemia Syndrome Evaluation (WISE) study into that condition. 

According to Bairey Merz and data from the WISE study, Ischemia with No Obstructive Coronary Artery Disease comprises roughly 25 to 30 percent of ischemic heart disease in women and 10 percent in men. These patients tend to feel some chest pain, but their main heart arteries are clear. Instead, blockages in these patients appear in the tiny microvessles around the heart, and those microvessle blockages do not show up on standard heart tests.  

Still, there is a "huge knowledge gap," Bairey Merz said, with many physicians failing to recognize heart disease in women because medical research has focused “over the last 40 years in men, for men and by men.”

Bairey Merz urged listeners to get educated on heart disease in women, who often experience different heart disease symptoms than men. For example, when having a heart attack, men are more likely to experience tingling in their left arm, while women are more likely to feel overshelming fatigue, nausea and jaw pain.

As Bairey Merz explains to The Curbsiders, data from the WISE study also shows that after diagnosis, women with the disorder face a 2.5 percent annual risk of dying, suffering a nonfatal heart attack or stroke, or being hospitalized for heart failure. They are also four times more likely than men to be readmitted to a hospital within 180 days of being treated for a heart attack or severe chest pain.

Click here to listen to the entire The Curbsiders podcast featuring Bairey Merz.

Read more on the Cedars-Sinai Blog: Fighting Heart Problems Before They Happen