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Meet the Expert

Martha Gulati, MD, MS, FACC, FAHA

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Heart Stress Tests Not Always Accurate In Women

Expert wants new female-friendly guidelines after decades of all-male data

As millions of women head back to the gym this new year to get fit, they’ll want to check with their doctor first to make sure they’re healthy enough for exercise. If that exam includes an exercise stress test, women should pay close attention to the results, says one Ohio State women’s heart health expert whose research claims stress tests are geared toward men and the results aren’t always accurate in women.

By simply hooking up a few sensors to a patient on a treadmill, stress tests can instantly tell doctors a lot about a patient’s heart, and are the the most commonly used method of diagnosing coronary artery disease (CAD) in women. For decades they have been the test of choice, and given how easy and inexpensive they can be, it’s not surprising.

“But what is surprising is the fact that all the research that describes stress testing initially, and that has gone on for almost more than 40 years, was only done on men,” says Dr. Martha Gulati, director for preventive cardiology and women’s cardiovascular health at The Ohio State University Medical Center.

Dr. Gulati, co-author of a review article in Circulation, The Journal of the American Heart Association on this very topic, emphasizes that since most of the body of research on stress testing is about men, current exercise stress test guidelines that determine who is fit, and how fit they should be, aren’t always accurate in women.

To change that, Dr. Gulati and a team of researchers have been following 6,000 women for nearly 20 years, putting them through countless exams and stress tests. Dr. Gulati and her team are finding the formula for heart health isn’t always the same for everyone.

“I looked at what a woman’s age-predicted fitness level should be and we found a completely different equation than what has been established in men,” Gulati says.

For example, readings known as S-T Segments measuring blood flow to the heart are often different in women. Additionally, factors like blood pressure and fitness level seem to play a different role than they do in men.

That’s information women like Harriett O’Toole, 72, of Columbus, Ohio, should know. This former marathon runner had a heart attack she never saw coming, although there were clues.

“Looking back and researching family members, the male side of the family had had many heart attacks, most of them fatal,” Harriett says.

Harriett’s experience and that of thousands of others is precisely why Gulati says women who get stress tests should ask about female-specific readings. Even if they look good today, these tests can hold clues to future problems, but only if they’re read properly.  

Dr. Gulati is in the process of writing new stress test guidelines specifically for women. Those guidelines could be complete in the coming year.

Above all, Dr. Gulati notes, if women schedule a stress test, they should talk with their doctor beforehand about interpreting those results.

**Exercise Stress Testing in Women: Going Back to the Basics, Circulation, Volume 122, Number 24, December 14, 2010.




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