Heart Attack Breakthrough

Women are nearly three times more likely to die from coronary heart disease than breast cancer, but diagnosis is often overlooked.

Every year in Scotland, 14, 000 men and 8, 000 women go to hospital due to a heart attack.

A study, funded by the British Heart Foundation, suggests a high sensitive blood test could double diagnosis rates in females. It included over 1,000 men and women admitted to the Royal Infirmary of Edinburgh with chest pain. Researchers from the University of Edinburgh evaluated the effectiveness of a blood test to measure troponin, a protein released from the heart during a heart attack. They compared the rate of diagnosis with the standard test, in routine use around the world, and the Abbott ARCHITECTSTAT High Sensitive Troponin-I (hsTnl) test, which can detect troponin at much lower levels.

Using the standard test with the same threshold for men and women, almost twice as many men (19%) as women (11%) were diagnosed as having had a heart attack. But when using Abbott's high sensitive test and different thresholds for men and women, the number of women diagnosed with heart attacks doubled (22%). This meant the proportion of men and women presenting to hospital with chest pains diagnosed with a heart attack would be the same.

The researchers also found that men and women only picked up using the high-sensitivity test and gender-specific thresholds were at increased risk of dying or having another heart attack in the subsequent 12 months. They are therefore likely to benefit most from the use of high-sensitivity testing.

Dr Anoop Shah, Clinical Lecturer in Cardiology at the University of Edinburgh, who worked on the study, said: "While similar numbers of men and women attend the A&E with chest pains, we wanted to know why women are less likely to be diagnosed with a heart attack. At the moment one in ten women with chest pains will be diagnosed with a heart attack compared to one in five men.

"Our findings suggest one reason for this difference in diagnosis rates of men and women is that we, as doctors, may have been using a threshold for troponin testing that is too high in women. Whether using different thresholds for men and women will lead to more accurate diagnosis and improve outcomes is now being evaluated in a large clinical trial funded by the British Heart Foundation."

Three weeks ago Jenni Stevens, 41, from Edinburgh, collapsed at work with chest pain. Jenni was rushed to the Royal Infirmary of Edinburgh. The high sensitive troponin blood test with the lower threshold for women was used to help diagnose a heart attack.

Jenni said: "I'd been having chest pains for about a month. As a working mum, I put it down to stress. But last week, as I was walking into work, the pain got much worse and I collapsed, causing my colleagues to call an ambulance.

"As much as I was frightened, I felt a sense of reassurance when I got to the hospital. They took my blood and did other tests. They thought I’d had a heart attack. I was treated with a stent to save my life. I'm genuinely so grateful that my heart attack was spotted and treated so well and with such compassion."

Professor Peter Weissberg, Medical Director at the BHF, which funded the study, said: "We have known for some time that women who have had a heart attack are less likely to be diagnosed than men but we have never had clear evidence as to why that is. But these important results indicate one potential reason.

"This research has shown that the results of the commonly used troponin blood test are significant at different levels in men and women. When the researchers took this into account, they found that twice as many women would be diagnosed with a heart attack.

"If these results are confirmed in the much larger clinical trial we're funding, these results suggest that using a high sensitivity troponin test, with a threshold specific to each gender, could save many more women's lives by identifying them earlier to take steps to prevent them dying or having another, bigger heart attack."