This picture comes from an intravascular ultrasound (IVUS) image from inside a heart artery. This is the same kind of technology that is employed in looking at the fetus in a pregant women. The black area in the center is the opening in the artery. It is wide open as you can easily see. There is no blockage at all. The green area is cholesterol plaque and in women with repeated chest pain, this plaque is evenly spread throughout the artery as you can see in the image below. This plaque can rupture or erode and then a clot that blocks the entire artery may occur when the arterial blood comes in contact with the raw surface. That is the way many heart attacks in women occur. That is how they are different.
You can easily see in the heart catheterization picture at the top, there is no blockage at all in this woman with repeated chest pain. The ultrasound images come from sections in the artery marked with beige lines. There is dangerous cholesterol plaque involving the entire artery with no blockage at all. Statins begin to stabilize this plaque so that it does not rupture within a couple of weeks. A stent won’t fix it. If you believe dangerous heart artery disease always involves a blockage, you will tell this woman she does not have heart artery disease. We can protect the women we care about now with optimal medical therapy. Translating this science to protect women with heart artery disease should be a national priority.
Bill, this is pretty amazing and explains so much about the differential treatment of heart disease for men and women. Why did it take so long to understand this?