The secret of the small arteries

April 21, 2015 | Patricia Harriman

When it comes to matters of the heart, men and women are different. When it comes to matters of heart disease, those differences can be deadly.

In fact, since 1984 more women than men have died each year from heart disease, making it the number one killer of women. A contributing factor is that the symptoms of heart disease in women are often different than men, and often misunderstood.

The angiograms of 50 percent to 60 percent of women with either an abnormal stress test, chest pain or symptoms of a heart attack will show clear arteries, prompting doctors to attribute the cause of their chest pain, shortness of breath, light-headedness or unusual exhaustion to something other than heart disease.

Heart disease with healthy arteries?

It’s a medical mystery – is it possible to have heart disease and yet have healthy coronary arteries?

“I continued to see patients with symptoms, and based on their risk factors, I believed they would have heart disease, but was not getting the expected answers when they would have an angiogram,” said Dr. Shaista Malik, medical director of the UC Irvine Health Preventive Cardiology Program and Women’s Heart Program as well as expert in women’s cardiovascular health.

The first important clue to understanding the unique features of heart disease in women was discovered during the WISE study, conducted between 1996 and 2000. The results of the angiograms, published in the Journal of the American College of Cardiologists in 2006, revealed that two-thirds of the 936 participants had a narrowing of the small arteries and blood vessels of the heart, rather than blockage in the large arteries of the heart like men.

Coronary microvascular disease

The term “coronary microvascular disease,” or MVD, was coined to describe the condition, and the way in which heart disease in women is diagnosed and treated began to change.

This predominantly women’s disease continues to be overlooked and under-diagnosed. The standard procedure for diagnosing heart disease is to administer an angiogram or a conduct a stress test. Complications arise when women’s results come back “normal” but the symptoms they are experiencing do not respond to standard treatment.

“This is a really important issue,” Malik said. “MVD or small vessel disease was thought to be a rare condition, but we are finding that the numbers are much greater than originally thought. Studies show that 40 to 60 percent of patients with chest pain or symptoms of heart disease have this condition and that it affects men as well as women.”

How disease is detected

MVD is difficult to detect, requiring more sensitive tests.

EndoPAT™ and Coronary Reactivity Test help detect MVD, but are not readily available. The EndoPAT is a non-invasive test that measures changes in function of the arteries. The Coronary Reactivity Test is an angiogram that examines how blood vessels in the heart respond to different medications which helps determine whether the microscopic size arteries are working normally.

At Malik's urging, UC Irvine Health became the only health system in Orange County and one of only two in the Southern California region to offer the EndoPAT and CRT tests.

“It’s cheaper to prevent a heart attack than it is to treat one,” Malik said.

Make an appointment

To make an appointment with UC Irvine Health Women's Heart Program, call 714-456-6699.


Lari Wenzel
April 30, 2015

I am so impressed with Dr. Malik's work, and her capacity to advocate for the best noninvasive technology to improve health for women. I want to schedule an appointment. Thank you for this announcement; I would otherwise not have known, and I am "pretty involved" in our activities.

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