Women's Physical Function Suffers More Than Men's From Cardiac-Related
Chest Pain, Says Emory Researcher
ATLANTA Women with chronic chest pain associated with angina pectoris
experience more detrimental effects on their quality of life than men,
according to a study published in the January issue of the journal Pain.
Angina pectoris occurs when
the demand for blood by the heart exceeds the supply of the coronary
arteries, causing a heavy or aching pain or discomfort in the center
of the chest. The condition is often triggered by physical activity,
mental stress or emotional upset.
Laura Kimble, PhD, associate
professor, Nell Hodgson Woodruff School of Nursing, Emory University,
along with colleagues from Emory and the University of Pennsylvania
School of Nursing, examined the gender differences in the characteristics
of chronic stable angina of coronary artery disease (CAD) patients.
According to the study, there were more similarities than differences
between men and women in self-reported chest pain characteristics. However,
despite the similarities, women reported having poor physical function
related to anginal pain.
Patients with a history of
coronary artery disease and angina pectoris documented by cardiologists
were recruited from four outpatient cardiology clinics for the study.
One hundred twenty-eight (128) subjects ranging in age from 35-86 years
old completed questionnaires that measured their social status, pain
intensity and perceived limitations of performing physical activities.
Subjects had to have experienced an episode of chronic stable angina
pectoris within the previous week and have at least a fourth grade reading
Results from the study suggests
that although both men and women report greater physical limitations
in the early years following a CAD diagnosis, men show little influence
on their perceived physical limitations as their years with the diagnosis
increased. Women show a considerable increase of their perceived physical
limitations, especially after ten years of more after being diagnosed
The Seattle angina questionnaire
(SAQ) was used to assess how the patient’s angina limited their common
daily activities based on three levels of physical exertion: low, medium
Low activities included ‘dressing
yourself,’ ‘walking indoors on level ground,’ and ‘showering.’ Medium
exertion activities included ‘climbing a hill or flight of stairs without
stopping,’ ‘gardening’, ‘vacuuming’,‘carrying groceries’ and ‘walking
more than a block at a brisk pace.’ High exertion activities were described
as ‘jogging or running,’ ‘lifting or moving heavy objects,’ and ‘participating
in strenuous sports.’ The possible range of scores for the physical
limitation subscale was 0-100, with higher scores indicating better
For the analysis, participants
in the study were divided into four groups according to the number of
years they had been diagnosed with heart disease- less than 4 years,
4-9 years, 10-14 years, and 15 or more years. Results suggest that for
men, the number of years diagnosed with CAD had little impact on their
perceived physical function. Men who had been diagnosed with CAD for
15 or more years had similar physical function as men diagnosed for
much briefer periods of time. In contrast, women who had been diagnosed
with CAD for 10 or more years demonstrated considerably lower physical
function compared to women who had been diagnosed for shorter periods
of time. A comparison between men’s Seattle Angina Questionnaire scores
who were between four to nine years following diagnosis and 16 or more
years following diagnosis, showed only an 8.3% decrease in their physical
function. The women’s scores, for similar groups, however, represented
a 52.2% decrease in physical function.
"My speculations are that
women may be avoiding physical activities and situations that trigger
anginal episodes," Dr. Kimble says. "Gradually over time, they may engage
in fewer physical activities which leads to physical deconditioning
and the onset of pain at even lower levels of physical activity. My
current and future research focuses on reversing that cycle."
The researchers also wrote
that "women’s perceptions of physical limitation may focus on traditional
activities that are common to women across the social spectrum, such
as household and caregiving tasks."
A separate short-form McGill
pain questionnaire (SF-MPQ) was used to evaluate how patients described
their pain. Using the provided pain descriptors, women were more likely
to describe their angina as "hot-burning" and "tender" and to have a
greater level of pain intensity for those descriptors. Men reported
the greatest pain intensity for the descriptors of "heavy" and "tiring-exhausting."
Researchers noted that the
burning sensations in the chest area that women were more likely to
describe are also characteristic of gastrointestinal disorders such
as gastroesophageal reflux disease.
"Similar sensory sensations
for chronic angina and other co-morbid conditions may make it difficult
for patients to ascertain the source of their symptoms leading to inappropriate
decision-making about when to seek medical attention and what physical
activity may be safely conducted," the researchers concluded.
There also needs to be further
study on women describing their pain as "tender," Dr. Kimble says. Tender
sensations felt in the breast are of CAD patients may be linked to the
hormonal changes in premenopausal women or hormone replacement therapy
in postmenopausal women.
"As we continue to study
and better understand the gender differences in the pain characteristics
of chronic stable angina, it will help us to determine if gender-specific
interventions are necessary to effectively reduce chronic angina-related
morbidity," Dr. Kimble says.
The research was funded by
the National Institutes of Health/National Institute of Nursing Research.