Heart Disease in Women: Which Test Is Best?

Jennifer Mieres, MD

Heart disease due to coronary artery disease is the leading cause of death of women in the United States. Women with heart disease are more likely than men to have more complications and a higher death rate. So early, accurate diagnosis is critical to prevent death from heart attack.

Exercise testing remains the most widely accessible and relatively inexpensive method for initial evaluation of suspected coronary disease and for assessment of its severity. Despite its commonplace use, there are reports of limited accuracy in diagnosing heart disease in at-risk women. So should women take the plain treadmill exercise stress test or is there a benefit to the more costly test of exercise testing combined with cardiac imaging--that is, exercise myocardial perfusion imaging, also known as a nuclear stress test?

During the What Is the Optimal Method for Ischemia Evaluation in Women (WOMEN) trial, my colleagues and I compared the plain exercise treadmill stress test to the nuclear stress test to evaluate 800 women with symptoms suggestive of heart disease who could exercise. All women could walk on the treadmill for at least six minutes. Half had only the plain exercise treadmill stress test and the other half were evaluated with exercise stress testing combined with myocardial perfusion imaging.

The women were followed for two years and evaluated for heart attacks, continued chest pain and cardiac death. Trial results, published in the American Heart Association journal Circulation, showed that an initial evaluation using only the exercise stress test provided two-year outcomes similar to those women who underwent the exercise nuclear stress test.

The bottom line: The plain exercise treadmill stress test should be the first test of choice for women with complaints suggestive of heart disease who can exercise for at least six minutes on a treadmill. Full Post - to Detail View

Cholesterol Awareness: Numbers You Need to Know

Jean Cacciabaudo, MD

When you need help, 911 is the number to call. But what are the numbers you should know to avoid needing that 911 help?

Each day 2,200 Americans die of cardiovascular disease -- that’s about one death every 39 seconds. Elevated lipid (fat) levels contribute to that risk. Knowing your lipid levels is one of the first health facts you should discuss with your healthcare provider. The good news is, you can lower cholesterol and reduce the risk of heart disease and stroke.

What should those numbers be?

  • In most people, a total cholesterol value should be less than 200 mg/dL.
  • Everyone should aim for a high level of the “good” cholesterol component, high density lipoproteins (HDL) greater that 45 mg/dL.
  • The “bad” cholesterol component, low density lipoproteins (LDL), should be less than 130 mg/dL overall but in patients with diabetes or known coronary or cerebrovascular disease, the LDL should be less than 70 mg/dL. Have a discussion about your ideal LDL level with your healthcare provider. Your personal risk factor profile may direct your goal to a level somewhere between the 70 and 130 mg/dL.
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New Medicine for Atrial Fibrillation Removes Need for Blood Tests

David Revere, MD

The FDA recently approved dabigatran to prevent stroke in patients with atrial fibrillation. This new development seems promising and provides additional benefits for patients.

Atrial fibrillation is a common abnormal heart rhythm. With atrial fibrillation, the top chambers of the heart do not beat normally and blood can pool and form a clot in part of the atrium (top chamber), which puts the patient at risk for stroke. Additionally, the heart muscle can become weak if the heart rate is too fast.

Cardiologists use medicines to slow down the fast heart rate and blood thinners to prevent stroke. The blood thinner used thus far has been warfarin, which requires frequent blood tests to maintain a sufficient level in the blood. Many patients have difficulty keeping the level in range, and often find the frequent blood tests bothersome.

Unlike warfarin, dabigatran requires no blood tests or monitoring and does not increase the risk of bleeding. The approval of the drug is a potential big win for both atrial fibrillation patients and cardiologists.

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