Abstract
Ischemic heart disease is underdiagnosed in women due to atypical symptomatology as well as to the lower specificity of several paraclinical tests, such as exercise stress testing. The aim of the study was to ascertain whether the Duke treadmill score (DTS) could be an efficient parameter in the diagnosis of ischemic heart disease in women. 105 patients were enrolled in the study, 45.71% women with average age ranged between 20 and 70 years, investigated in the Rehabilitation Hospital, Cardiology-Departament, Cluj-Napoca, Romania. All the patients were clinically assessed as concerns the presence of cardiovascular risk factors, and they underwent electrocardiographic, echocardiographic and treadmill stress tests. DST was calculated according to the formula: exercise time--5 x (ST deviation expressed in mm-4 x Angina Index). DTS was lower in women as compared to men: 2.54 +/- 5.36 vs. 6 +/- 4.69, p=0.0006. 54.28% of the patients were ranged with a low DTS risk category, whereas 45.71% belonged to a moderate and high risk category. DTS was significantly lower in women than in men with high blood pressure (2.03 +/- 4.8 vs. 5.8 +/- 4.28), hypercholesterolemia (1.14 +/- 4.51 vs. 6.24 +/- 4.13), diabetes mellitus (1.83 +/- 3.73 vs. 6.13 +/- 4.8), and obesity (2.42 +/- 5.35 vs. 5.81 +/- 4.64). By analyzing the presence of cardiovascular risk factors only in women, we noticed that only those with high blood pressure (2.03 +/- 4.89 vs. 8.13 +/- 7.85) and hypercholesterolemia (2.31 +/- 4.76 vs. 3.89 +/- 5.95) had a statistically significant low DTS (p<0.05). In conclusion, our research, which showed differences in DTS between women and men, raises concerns about the early diagnosis of ischemic heart disease in women.
Highlights
Cardiovascular diseases are responsible for most deaths in women worldwide
Women suffering from angina pectoris are less likely than men to perform exercise treadmill tests or angiographies, despite the presence of CV symptoms and risk factors, which stratify them into high risk classes [15]
Duke Treadmill Score (DTS) was significantly lower in women with cardiac risk factors, including hypertension, diabetes mellitus, high plasma lipid fractions values, obesity, than in men
Summary
Cardiovascular diseases are responsible for most deaths in women worldwide. Cardiovascular disease represents among Europe the leading cause of death in women. About 55% of deaths in women are due to these diseases, especially coronary heart disease and stroke [1,2,3,4,5,6,7,8]. The last years have brought an upswing in the diagnosis and clinical management of women with different cardiovascular diseases, their risk of developing ischemic heart disease is still underestimated. This might be related with the perception that premenopausal women are protected by their hormones. Investigating the relation between different cardiovascular (CV) conditions and the DTS may contribute to an early diagnosis and proper therapy of coronary artery disease (CAD) and may advance the knowledge on this topic
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