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30th March 2015

Women and heart attacks: could a new test spot them earlier?

Heart disease is the leading cause of death in women, claiming the lives of more than three times the number of women as breast cancer. But what if there was an easy way to tell if a woman is having a heart attack? According to a new study, there may be.  


When 41-year-old Jenni Stevens from Edinburgh began to have chest pains, she dismissed them, assuming they were caused by stress. It was only after the pains got much worse that a colleague called an ambulance for her and she was taken to the hospital. “As much as I was frightened, I felt a sense of reassurance when I got to the hospital,” says Stevens. “They took my blood and did other tests.”

It was one of these tests – a new, sensitive troponin test – that saved her life. Doctors were able to quickly determine that she was having a heart attack and give her the care she needed. “I was treated with a stent to save my life. I’m genuinely so grateful that my heart attack was spotted and treated so well and with such compassion,” Stevens explains.

Troponin tests look for traces of proteins in the bloodstream that are released when the heart cells have been damaged by lack of blood supply. If a patient’s troponin levels are high enough, it is assumed that they have suffered a heart attack.

Until recently, men and women were diagnosed using the same test. However, a study published in the British Medical Journal suggests that women who are actually having a heart attack may be misdiagnosed because their troponin levels are lower than the standard threshold. A new, more sensitive troponin test identifies these women, increasing the likelihood that they will receive the care they need.

Funded by the British Heart Foundation, the study looked at the diagnoses of 1,126 women and men who had been admitted with a suspected heart attack. Using the standard troponin test, 55 women were diagnosed as having a heart attack, compared to 117 men. When using a more sensitive test, the number of women doubled to 111, while only a handful of additional men were diagnosed as having a heart attack.

Researcher Dr. Anoop Shah explains that while similar numbers of men and women are admitted to the hospital with chest pains, women are less likely to be diagnosed with a heart attack.


“At the moment, one in 10 women with chest pains will be diagnosed with a heart attack, compared to one in five men,” says Dr. Shah. “Our findings suggest one reason for this difference in diagnosis rates of men and women is that we, as doctors, may have been using a threshold for troponin testing that is too high in women.”

During the study, researchers also found that women are less likely than men to be referred to a cardiologist or to receive other secondary prevention. This was especially true of the women who would not have been identified by the older, less-sensitive troponin test. After 12 months, these same women showed higher rates of mortality and recurrent heart attacks than the women whose troponin levels were high enough to be identified by the older test.


“For some reason, women are less likely to have obvious symptoms, and if the test result comes back negative then they might be sent home only to have an event [heart attack] in the next few months because they were not treated appropriately,” explains Dr. Shaw.

While more research is needed to determine if and how the sensitive troponin test will save lives, professor Peter Weissberg of the British Heart Foundation believes that the results from initial study are promising. According to Weissberg, the new tests “could save many more women’s lives by identifying them earlier to take steps to prevent them dying or having another, bigger heart attack.”

Sources:

http://www.bmj.com/content/350/bmj.g7873

http://www.bbc.com/news/health-30896795

http://www.nhs.uk/Livewell/women4060/Pages/women-and-heart-disease.aspx

Credit: Flickr/Ed Yourdon