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Is it a heart attack? Study seeks to improve diagnosis and care for women

February is Heart Month, a time to bring attention to the importance of cardiovascular health, and what we can do to reduce our risk of cardiovascular disease. So, we’re shining a spotlight on Dr. Karin Humphries, who researches sex and gender differences in coronary artery disease. On Feb. 13, Dr. Humphries will be among the speakers at a free educational event on women’s cardiovascular health (scroll down for details).

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Heart disease is a leading cause of death among women in Canada. And yet, according to the Heart & Stroke Foundation, the bulk of heart disease research focuses on men. Not only are females with heart disease under-researched, they are also under-diagnosed and under-treated. Meanwhile, the risk of death among women under 55 who have had a heart attack is twice that of men the same age.

One scientist who is working to close the research gap and stop women from dying unnecessarily is Dr. Karin Humphries, Scientific Director at the BC Centre for Improved Cardiovascular Health, Associate Professor in the Faculty of Medicine at the UBC, and UBC-Heart and Stroke Foundation Professor in Women’s Cardiovascular Health. Thanks to a $1.6 million federal grant, Dr. Humphries and her research team will soon launch the CODE-MI study to investigate whether one simple change in how we diagnose a heart attack could improve care for women with heart disease and reduce their risk of dying.

We reached out to Dr. Humphries to learn more.

First, some background. How are women’s hearts different from men’s hearts?

KH: On average, women’s hearts are smaller than men’s hearts. We are also more likely to develop coronary artery disease in the smaller blood vessels of the heart, the ‘microvasculature’, than men in whom the disease is more likely to manifest in the larger ‘epicardial’ vessels. This is an important difference given that our major diagnostic tool is designed to demonstrate disease in the larger epicardial vessels.

What are the signs and symptoms of heart attack in women and how do men experience heart attack differently?

KH: In both women and men, chest pain is the most common symptom of a heart attack, but women may describe this pain as squeezing or fullness anywhere in the chest rather than a crushing pain in the centre of the chest. Women also experience other symptoms called ‘atypical’ symptoms. These include pain in the arm(s), jaw, neck or shoulder, shortness of breath, nausea, light-headedness, sweating or extreme fatigue. While men may only describe chest pain, women will often describe two or more symptoms, in addition to chest pain.

Are there unique risk factors for heart disease in women?

KH: Yes, there are risk factors that are unique to women. These include pre-eclampsia or gestational diabetes during pregnancy. Women who have polycystic ovary syndrome (PCOS) are also at increased risk of heart disease. In addition, two risk factors, diabetes and smoking, which are risk factors in both sexes, have a stronger effect in women than in men.

What is the objective of the CODE-MI study?

KH: CODE-MI is a randomized controlled trial that seeks to improve the diagnosis and treatment of women with a heart attack by using a diagnostic cut-point that is specific for women, rather than an overall cut-point. The biomarker that is used to diagnose a heart attack is ‘cardiac troponin’. Because women produce lower levels of this biomarker than men, we believe it is important to take this fact into account and adjust the cut-point to reflect the lower levels found in women.

How will the study be conducted?

KH: The study will be carried out within 26 hospitals across Canada. In BC, Victoria’s Royal Jubilee Hospital and Vancouver’s St. Paul’s Hospital are participating. Each hospital is currently using an overall cut-point for cardiac troponin when evaluating people presenting to the emergency department with chest pain. As part of the study, the sites will be randomized to start using the lower cut-point when evaluating women. The cut-point for men will remain the same. We hope to show that more women will be appropriately identified as having a heart attack after the implementation of the lower cut-point.

How could this research lead to better care and outcomes for women?

KH: If we are better able to identify women who have had a heart attack, we can then offer them better care. And with better care we can improve the chances they will make a full recovery from their heart attack.

Is there anything women can do to prevent heart disease?

KH: Women can make several changes that will reduce the chance of getting heart disease. These changes include regular physical activity, eating a heart healthy diet, and not smoking. It is also important to work with their doctors to maintain healthy levels of cholesterol and blood pressure.

Wear Red Canada event

The Canadian Women’s Heart Health Alliance in collaboration with The Heart and Stroke Foundation of BC & Yukon are launching the inaugural Wear Red Canada campaign on Wednesday, February 13.

On this day, cardiologist Dr. Tara Sedlak is hosting an informational event where cardiovascular experts and patients will share their knowledge and experiences. Dr. Humphries is among the speakers, as is St. Paul’s Hospital cardiologist Dr. Annie Chou, who will talk about gender-specific risk factors leading to heart disease in women, as well as the signs and symptoms of heart disease in women. Click here for event details.

When: February 13, 2019 | 9:30 a.m.-12 p.m.
Where: UBC Robson Square C300 (800 Robson St.)
To RSVP: Dr. Tara Sedlak (mahrazparvand@alumni.ubc.ca

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This article originally appeared on The Daily Scan.