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Learning From WISE Women

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Learning from the WISE Women:
Finding Heart Disease in Women

Find out what makes a woman's heart tick

Heart disease often looks different in women than it does in the typical male, researchers say. Because of this, it's not easily seen with the usual tests. Traditional surgical procedures may not work either. For many women, this may mean heart disease goes undetected and untreated. But a landmark study is changing how doctors test and treat women with heart disease.

Not your every day plaque

The multi-center study is called The Women's Ischemia Syndrome Evaluation (WISE). It has found that plaque is different in women.

Plaque is the buildup of cholesterol and other substances along the lining of the main arteries in the body, including the heart. We usually think of the plaque building up in the big arteries supplying the heart, creating an obvious blockage that reduces blood flow. At least two things are different in women:

  • Plaque builds up more evenly along artery walls. So, it doesn't always look like the obvious "roadblock" plaque that's most typical in men. This is due to differences in the cells lining the heart's arteries. The diffuse buildup also makes blood vessels less elastic, so they can't dilate as well for increased blood flow. This form of heart disease is also hard to diagnose using traditional tests such as angiogram, which is designed to pick up the bulging artery-blocking plaque.
  • Plaque buildup affects the tiny blood vessels in the heart, rather than the major arteries. This is called microvascular or microvessel disease. It's also more common in people with diabetes. Coronary artery disease in the tiny blood vessels in the heart must be treated differently because surgeons can't get in there with angioplasty, stents or bypass surgery. Instead, doctors rely more on medications to control symptoms.