This is the most critical landmark medical study impacting women’s health by far. When it comes to heart artery disease in women, the specific research as been done. The study was initiated in 1996. It builds on information from two other landmark studies. Peter Libby in 1995 taught us that heart attacks do not occur from a gradual chronic closure of an artery. They do not occur from long-standing blockages, and therfore, a stent or a bypass does not prevent heart attack or sudden death. Heart attacks occur when inflammed cholesterol desposits burst open or erode and start a clot that blocks the artery. Erling Falk and his colleagues brought together information from four studies that showed two thirds of heart attacks occur in arteries that were blocked less than 50% prior to the acute event. The Women’s Ischemic Syndrome Evaluation (WISE) study built on this information from the previous year and showed unequivocally that women often have cholesterol deposits that involve most of the artery surface without causing a blockage. Women are even more likely to have a heart attack in an artery without a previous blockage than men.
Cardiovascular disease is the leading healthcare threat to American women. This single effort from the NIH has produced dozens of articles that should inform our management of women with heart artery disease. By 2006, this summary report and the references attached to it provided a body of knowledge to change our treatment. Nothing in in American medical practice is more important than translating this research.
By 2004, we knew definitively that women with repeated chest pain and no blockages have an increased risk of death, cardiovascular events, and hospitalizations compared with women who do not have chest pain. Of the women in the WISE study with repeated chest pain, 20% were dead within 9 years (average age 67). One third of these women had no heart artery blockages and many of them were told they did not have heart disease. That is 18 years ago. That is longer than the average 17-year gap between new medical science and its broad adoption in medical practice. Our system still treats these women as if they are low risk and that is a grave mistake. The specific research on women has been done, but they are still not protected. We have not translated it. Knowing and not acting is worse than not knowing.
Over the last week, you have read about my neighbor Jean who is a woman with no artery blockages and repeated chest pain. Like most of my patients, she was dramatically better with no chest pain within weeks after beginning optimal medical therapy (OMT). That is the key. We must identify these women and develop the systems to produce OMT consistently for them and other patients with cardiovascular and related conditions.
Most of my readers are women who are teaching others how to care for patients. I am calling on you to begin putting this information in your curriculum. It is time protect women by translating this new science into action. You are also in a unique position to help develop the systems to produce OMT consistently. I welcome your ideas on ways we can protect women with heart disease sooner. Please comment.
has failed to represent the needs of women with heart disease. The swamp creatures of NIH are stoogies of the big pharma and device comoanies. They do not promote evidence based medical decision making. They promote "what makes the most profits" for their pay maters of the big pharma.