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.
Material and method. 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).
Results. 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.
1. NEWBY KL, DOUGLAS PS. Cardiovascular disease in women. In: Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 9th edition. Philadelphia: Elsevier Saunders, 2011;1757-1769.
2. MOSCA L, BENJAMIN EJ, BERRA K, BEZANSON JL, DOLOR RJ, LLOYD-JONES DM, et al. Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women – 2011 Update: a guideline from the American Heart Association. Circulation 2011; 123: 1243-1262.
3. ALFONSO F, BERMEJO J, SEGOVIA J. Cardiovascular disease in women. Why now? Rev Esp Cardiol 2006; 59: 259-263.
4. STRAMBA-BADIALE M, FOX KM, PRIORI SG, COLLINS P, DALY C, GRAHAM I, et al. Cardiovascular diseases in women: a statement from the policy conference of the European Society of Cardiology. Eur Heart J 2006; 27: 994-1005.
5. WENGER NK, SHAW LJ, VACCARINO V. Coronary heart disease in women: update 2008. Clin Pharmacol Ther. 2008; 83: 37-51.
6. PILOTE L, DASGUPTA K, GURU V, HUMPHRIES KH, MCGRATH J, NORRIS C, et al. A comprehensive view of sex-specific issues related to cardiovascular disease. CMAJ 2007; 176: S1-S41.
7. ANDREOTTI F, MARCHESE N. Women and coronary heart disease. Heart 2008; 94: 108-116.
8. ANAND S, ISLAM S, ROSENGREN A, FRANZOSI MG, STEYN K, YUSUFALI AH, et al. Interheart Investigators. Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J. 2008; 29: 932-940.
9. GO AS, MOZAFFARIAN D, ROGER VL, BENJAMIN EJ, BERRY JD, BORDEN WB, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2013 Update: A Report From the American Heart Association. Circulation. 2013; 127:e6-e245.
10. POP D, DĂDÂRLAT A, ZDRENGHEA D. Novel cardiovascular risk markers in women with ischaemic heart disease. Cardiovasc J Afr. 2014; 25(3):137-4.
11. The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). 2007 Guidelines for the management of arterial hypertension. Eur Heart J. 2007; 28:1462–1536.
12. Coordinating Committee of the National Cholesterol Education Program. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation. 2004; 110: 227-239.
13. ZDRENGHEA D, POP D. Testarea de efort în practica medicală. Ed. Clusium, Cluj-Napoca. 2012.
14. MIERES JH, SHAW LJ, ARAI A, BUDOFF MJ, FLAMM SD, HUNDLEY WG, et al. Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention, American Heart Association. et al. Role of noninvasive testing in the clinical evaluation of women with suspected coronary artery disease: Consensus statement from the Cardiac Imaging Committee, Council on Clinical Cardiology, and the Cardiovascular Imaging and Intervention Committee, Council on Cardiovascular Radiology and Intervention American Heart Association. Circulation 2005; 111: 682-696.
15. CRILLY M, BUNDRED P, HU X, LECKEY L, JOHNSTONE F. Gender differences in the clinical management of patients with angina pectoris: a cross-sectional survey in primary care. BMC Health Serv Res 2007; 7: 142-150.
16. DALY C, CLEMENS F, LOPEZ SENDON JL, TAVAZZI L, BOERSMA E, DANCHIN N, et al. EURO HEART SURVEY INVESTIGATORS. Gender differences in the management and clinical outcome of stable angina. Circulation 2006; 113: 490-498.
17. POP D, SITAR-TǍUT A, ZDRENGHEA D. Cardiopatia ischemicǎ. In: Mitu F, Pop D, Zdrenghea D. Particularităţi ale patologiei cardiovasculare la femei. Editura Pim. Iaşi. 2012; 87-110.
18. KOHLI P, GULATI M. Exercise stress testing in women: going back to the basics. Circulation. 2010; 122:2570-80.
19. ALEXANDER KP, SHAW LJ, SHAW LK, DELONG ER, MARK DB, PETERSON ED. Value of exercise treadmill testing in women. J Am Coll Cardiol. 1998; 32:1657-64.
20. KLIGFIELD P, LAUER MS. Exercise electrocardiogram testing: beyond the ST segment. Circulation. 2006; 114:2070–2082.
21. MARK DB, SHAW L, HARRELL FE JR, LEE KL, BENGTSON JR, MCCANTS CB, et al. Prognostic value of a treadmill exercise score in outpatients with suspected coronary artery disease. N Engl J Med. 1991; 325:849–853.
22. GULATI M, ARNSDORF MF, SHAW LJ, PANDEY DK, THISTED RA, LAUDERDALE DS, et al. Prognostic value of the duke treadmill score in asymptomatic women. Am J Cardiol. 2005; 96:369-75.
23. ADEKUNLE AE, AKINTOMIDE AO. Gender differences in the variables of exercise treadmill test in type 2 diabetes mellitus. Ann Afr Med. 2012; 11:96-102.
24. LAKKIREDDY DR, BHAKKAD J, KORLAKUNTA HL, RYSCHON K, SHEN X, et al. Prognostic value of the Duke Treadmill Score in diabetic patients. Am Heart J. 2005; 150:516-21.
25. RAFIE AH, DEWEY FE, MYERS J, FROELICHER VF. Age-adjusted modification of the Duke Treadmill Score nomogram. Am Heart J. 2008; 155:1033-8.