Q: My 82-year-old mother is having angina when she exerts herself. She is scheduled for an angiogram and maybe angioplasty. I've heard that women's heart disease is different from men's and that angioplasty may not be as effective in women. Should she get the angiogram?
A: I think an angiogram is a reasonable choice for your mother, assuming that she's had a good trial of medicines like beta blockers and calcium-channel blockers. If she is still limited by her symptoms despite taking medication, then angioplasty might really improve her quality of life.
An angiogram is a diagnostic test that involves looking for blockages in the coronary arteries that supply the heart. Angioplasty opens up closed coronary arteries, so blood can flow through.
Heart disease rates have been falling over the past few decades thanks to the use of statins, the decline in smoking, and the control of high blood pressure. Still, for people like your mother who live into their 80s, the risk of heart disease creeps up simply because of advancing age.
There are some important differences between male and female heart disease. For example, women tend to be older than men when they get heart disease because estrogen, the female hormone, protects the hearts of younger women. Older women "catch up" with men after menopause, when estrogen levels fall.
Women may also be less aware than men about when their heart disease has started. Things are changing, but as a rule, older women tend to be less active than older men, so they aren't as likely to experience the classic symptom of chest pain that occurs with physical exertion. As a result, by the time many women become aware of their heart disease, it's often more advanced and will occur with lower levels of exertion. For many women, the main symptom of heart disease is fatigue.
Once heart disease occurs, the diagnosis and treatments should be the same regardless of gender. The general principle of trying to restore blood flow through the coronary arteries that supply the heart is the same. That's usually accomplished with angioplasty, as you mentioned, or with a coronary artery bypass operation. Women have smaller hearts and arteries than men, so these procedures are a bit harder to perform in women than in men. Even so, they're just as effective.
(Soheyla Gharib, M.D., is an associate clinical professor of medicine at Harvard Medical School and Chief of Medicine of Harvard University Health Services.) (For additional consumer health information, please visit www.health.harvard.edu.)