A new consensus statement from the American Heart Association (AHA) on ischemic heart disease emphasizes the importance of non-obstructive coronary disease (CAD) in women as an indicator of an elevated risk of heart attack. The statement was published in the journal Circulation.

Since the AHA’s initial review in 2005 on the use of CAD imaging for evaluating symptomatic women with suspected myocardial ischemia, new evidence has emerged to support sex-specific data relating to patterns and distribution of non-chest-related pain symptoms. While the most common symptom of myocardial ischemia is chest pain for both men and women, women’s ischemic symptoms are often precipitated by mental or emotional stress rather than physical activity.

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Women also report epigastric discomfort and associated nausea, radiation of discomfort to the arms, neck, and interscapular areas, and dyspnea and fatigue. Non-obstructive coronary artery disease and coronary microvascular disease are more common in women but have only recently been linked with abnormal stress tests to an elevated risk of heart attack.

Recommendations from the statement include:

  • Women with suspected ischemic heart disease should discuss the benefits and risks of diagnostic tests with their healthcare provider, such as if a woman of child-bearing age should avoid tests that require exposure to radiation.
  • Healthcare professionals should consider whether a woman is at low, intermediate, or high risk for ischemic heart disease when determining the appropriate diagnostic tests for their patients, with risk levels based partly on age combined with risk factors such as diabetes and high blood pressure.
  • Health care professionals, for the first time, should consider a woman’s functional ability, which is her ability to carry out the activities of daily living to determine the type of diagnostic testing needed. Women with low functional disability are now considered at increased risk for heart attack.
  • Women with the lowest risk should not undergo diagnostic testing; women at slightly higher risk should first undergo a treadmill exercise ECG (electrocardiogram); and symptomatic women with warning signs, including functional disability, might be candidates for cardiac MRI (magnetic resonance imaging) or cardiac CT angiography (computed tomography that looks at the heart).

For more information visit Heart.org.