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 Overall, reduced blood flow – called ischemia – was more common in
men than in women, and anxiety disorders weren’t generally linked to
higher or lower risk of ischemia, said senior author Kim Lavoie of
the University of Quebec at Montreal.
However, women without previously diagnosed heart disease who had
anxiety disorders, including things like panic disorder and
generalized anxiety, had higher rates of ischemia compared to those
without anxiety disorders, she told Reuters Health by email.
The researchers studied the risk of myocardial ischemia, when blood
flow to the heart is reduced, usually due to a partial or complete
blockage of the heart’s arteries. Ischemia may cause chest pressure
or pain, shortness of breath, neck or jaw pain, or may have no
symptoms.
Ischemia (pronounced iz-kemia) can be treated with medications,
surgery or both.
For the study, more than 2,300 people, including 760 women,
completed exercise stress tests and had psychiatric interviews to
assess mood and anxiety disorders.
For women without a history of coronary artery disease, those with
anxiety were more likely to exhibit ischemia during exercise
compared to women without anxiety.
Anxiety was not tied to ischemia risk for men or for women with a
history of coronary artery disease, as reported in the special
issue.
Experts have been aware of the sex and gender disparities in heart
disease detection, treatment and outcomes for some time, but
physicians may still be mistaking heart disease for anxiety in some
women, Lavoie said.
“Men and women with heart disease often present with different
symptoms: more 'classic' symptoms like chest pain and shortness of
breath tend to be observed in men, where less 'classic' symptoms
like fatigue, hot flashes, back/neck pain are more often observed in
women,” she said.
So anxiety may "mask" symptoms of heart disease among women, leading
to diagnostic and treatment delays, she said.
It is also possible that anxiety may increase the risk of ischemia
by increasing heart rate and blood pressure, Lavoie said.
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“The idea that stress can be related to ischemia and even a heart
attack is an important message to get across,” said Dr. Carolyn Lam
Su Ping, senior consultant of the National Heart Center in Singapore
and associate professor of Duke-NUS Cardiovascular Academic Clinical
Program.
The current thinking is that emotional or mental stress itself can
actually cause coronary arteries to go into spasm, without an actual
blockage, Lam, who was not part of the news study, told Reuters
Health by phone.
Lam is not fully convinced that women with anxiety symptoms are not
taken as seriously, she said.
“But it’s true that a woman with anxiety compared to one without
anxiety, it may be doing damage to their heart,” she said.
A different study would need to assess whether intervening and
treating anxiety changes the risk of ischemia during stress testing,
Lam said.
“The number one cause of death among women is heart disease,” which
will kill 50 percent of women and men, Lavoie said.
Quitting smoking, eating a healthy diet and maintaining a healthy
weight, exercising and reducing the amount of time you are
sedentary, getting enough sleep and managing stress all reduce heart
risk, she said.
“If you have a mood or anxiety disorder, many excellent treatments
are available; the most efficacious is some form of
cognitive-behavior therapy with or without medication,” she said.
SOURCE: http://bit.ly/XaY6j7 Circulation: Cardiovascular Quality and
Outcomes, online February 23, 2016.
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