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February 11, 2003


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 level.

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 with CAD.

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 and high.

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 physical function.

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.

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