General Medical · Health

Coronary Artery Disease in Women: What Are the Options When an Artery Is Blocked?

Heart disease remains the No. 1 killer of women; indeed, it accounts for 35 percent of all deaths in women. One in three women will develop a blocked artery in her lifetime.  Having an understanding of treatment options can empower you to make better choices for yourself or a loved one.

In a prior post I reviewed coronary artery disease (CAD) in women, detailing how heart arteries become blocked with atherosclerotic plaque and pointing out the symptoms that this may produce.  This article will focus on a more advanced state of CAD—the treatment of a woman with a partially or completely occluded coronary artery.

Coronary artery disease can be immediately life-threatening, but it can also be a long-term chronic condition with a relatively low risk. The diagnostic power of a detailed medical evaluation is never more apparent than when used in CAD cases to determine whether the patient’s angina (discomfort from the heart)  should be considered stable or unstable, allowing rapid assessment of a patient’s risk. 

Stable Angina

In stable angina, symptoms are produced at a level of activity that is predictable from day to day, and the discomfort rapidly dissipates with rest.  A common scenario is to have discomfort after walking up an incline, particularly when carrying a heavy package; the discomfort rapidly abates at the top of the hill. The responsible coronary blockage may occupy 75 percent or more of the coronary artery; it is most commonly composed of atherosclerotic plaque with a thick, fibrous cap that provides a resilient barrier isolating the plaque contents from the bloodstream.  Stable angina is the most common symptom of CAD in women—more common in women than in men.

“Revascularization”—the insertion of a stent to eliminate the blockage, utilizing a percutaneous coronary intervention (PCI, or angioplasty), or the surgical placing of a bypass graft around the coronary blockage (coronary artery bypass grafting, or CABG)—has a role in treatment for some women. Nevertheless, it is important to understand that in cases of stable angina, the risk of myocardial infarction (heart attack, or MI) or death is fairly low with optimal medical management.  One hundred and seventy thousand angioplasties are performed annually in this country, one third of them in women. Recent reports have indicated that in this stable group, PCI may be over-utilized.

Next page: Unstable Angina and the Effectiveness of Angioplasty

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