The Daily Observer London Desk: Reporter- John Furner
Women at high risk from a type of genetic heart disease that affects 250,000 Britons may have the severity of their condition ‘underestimated’ by doctors, researchers have claimed.
A study has found that women with dilated cardiomyopathy – which causes the chambers of the heart to stretch, hindering its pumping action – are twice as likely as men to be hospitalised or need a heart transplant within two years of diagnosis. The findings came despite tests at the start of the study showing the female participants were healthier overall. Experts say this would understandably lead doctors to be ‘falsely reassured’ that the women had a milder form of the disease, requiring fewer follow-up appointments and less medication.
But the study shows women with a high risk of complications from the condition – including potentially fatal heart failure – are flying under the radar.
A study has found that women with dilated cardiomyopathy – which causes the chambers of the heart to stretch, hindering its pumping action – are twice as likely as men to be hospitalised or need a heart transplant within two years of diagnosis
Dr Paz Tayal, a cardiologist at Imperial College London who led the research, says: ‘My worry is we may be missing higher-risk patients. By rights we’d expect these women to do well when we followed them up, but what we found was the opposite. That paradox is the real puzzle.’
She adds: ‘Despite what looked like a better starting point, the women had twice as many complications – particularly heart failure-related problems – compared with male patients. And it happens quite early.
‘Doctors should not necessarily be reassured by what looks like a milder disease in female patients. They may need to be followed up more often and doctors should make sure they’re on the full range of appropriate drugs.’
In a third of cases, dilated cardiomyopathy is caused by faulty genes, but it can also be triggered by viruses, an unhealthy lifestyle, medical problems such as high blood pressure or, rarely, from pregnancy. Symptoms include breathlessness, fatigue and fluid accumulating in the legs. Most people can manage the condition with medication, and for about half of patients the heart will return to a normal size.
But one in five will end up developing serious complications including fluid in the lungs, dangerous heart rhythms, heart failure – when the organ becomes irreversibly damaged and progressively less able to pump properly – or death within five years of diagnosis. Some may need a heart transplant or to be fitted with an pump called a ventricular assist device that helps the heart beat properly.
The latest study is the first to conclusively show women are more likely to suffer these complications within the first two years of diagnosis. It found 8.6 per cent of female participants were admitted to hospital for these problems compared with 4.4 per cent of men. However, because they appeared healthier, they were less likely to raise red flags for doctors.
The latest study is the first to conclusively show women are more likely to suffer these complications within the first two years of diagnosis. It found 8.6 per cent of female participants were admitted to hospital for these problems compared with 4.4 per cent of men. However, because they appeared healthier, they were less likely to raise red flags for doctors
The women’s hearts were less enlarged than the men’s, they had less scarring, known as fibrosis, in the walls of the heart – which can predict a poorer outlook – and they also had lower levels of troponin, a protein which can indicate a problem with the heart’s function.
The results were found to be the same regardless of whether women had a genetic trigger for the disease or if it developed for other reasons.
‘We don’t yet know what is driving this but we think it’s specifically something to do with female biology,’ Dr Tayal adds. ‘We need to do more research but it’s important women with the condition and doctors, too, recognise their risks may be greater than expected.’
The study adds to a growing body of research suggesting women experience heart problems differently to men and need to be treated differently.
Women suffering a heart attack, for instance, are more likely to experience fatigue and back pain rather than crushing chest pain. Heart disease – the leading cause of a heart attack – is the biggest killer of women in the UK.
Dilated cardiomyopathy is diagnosed via a test to measure a protein called BNP in the blood, as well as an MRI or electrocardiogram scan. A genetic test may be performed if a family history of heart problems is evident. If the results are positive, screening is offered.
Four types of medication are given, including beta blockers and ACE inhibitors along with drugs that help reduce fluid retention and treat heart failure.
Dr Tayal claims the ‘vast majority’ of patients with the condition responded well to treatment, adding: ‘But we need to work out early who those people at greatest risk of complications are going to be, and do more work to find out not only why women are affected differently but what we can do about it.’
