Background: Black women are less likely to be evaluated and treated for anginal symptoms, despite a higher premature cardiac mortality rate compared to white women. Our objective was to compare angina symptoms in black versus white women regarding (1) angina symptoms characterization; (2) relationship with obstructive coronary artery disease (CAD); and (3) relationship with subsequent mortality. Methods: A cohort of 466 women (69 black and 397 white) undergoing coronary angiography for suspected ischemia and without prior history of CAD completed symptom checklists. Four symptom clusters (CHEST, UPPER, STOMACH, and TYPICAL TRIGGERS) were derived by factor analysis. All angiograms were analyzed by core lab. Mortality data over 10 years were obtained from National Death Index. Results: (1) Black women had lower mean CHEST cluster scores (0.60 -0.30 vs. 0.73 -30, p = 0.002), but higher STOMACH scores (0.41 -0.25 vs. 0.30 -0.25, p = 0.011) than white women. (2) Prevalence and severity of CAD did not differ in black and white women and was not predicted by symptom cluster scores. (3) All-cause mortality rates were 24.9% in blacks versus 14.5% in whites, p = 0.007; and cardiovascular mortality 22.5% vs.8.8%, p = 0.001. Symptom clusters were not predictive of adverse events in white women. However, black women with a low TYPICAL score had significantly higher mortality compared to those with a high TYPICAL score (43% vs. 10%, p = 0.006). Conclusions: Among women undergoing coronary angiography, black women report fewer chest-related and more stomach-related symptoms, regardless of presence or severity of CAD, and these racial symptom presentation differences are linked with the more adverse prognosis observed in the black women. Atypical symptom presentation may be a barrier to appropriate and timely diagnosis and treatment and contribute to poorer outcomes for black women.

Objective-This study investigated the relationship between psychotropic medication use and adverse cardiovascular (CV) events in women with symptoms of myocardial ischemia undergoing coronary angiography.Method-Women enrolled in the Women's Ischemia Syndrome Evaluation (WISE), were classified into one of 4 groups according to their reported antidepressant and anxiolytic medication usage at study intake: (1) No medication (n=352); (2) Anxiolytics only (n=67); (3) Antidepressants only (n=58); and (4) Combined antidepressant and anxiolytics (n=39). Participants were followed prospectively for the development of adverse CV events (e.g., hospitalizations for nonfatal myocardial infarction, stroke, congestive heart failure, and unstable angina) or all cause mortality over a median of 5.9 years.Results-Use of antidepressant medication was associated with subsequent CV events (HR= 2.16, 95% CI 1.21 to 3.93) and death (HR= 2.15, 95% CI 1.16 to 3.98) but baseline anxiolytic use alone did not predict subsequent CV events and death. In a final regression model that included demographics, depression and anxiety symptoms, and risk factors for cardiovascular disease, women in the combined medication group (i.e. antidepressants and anxiolytics) had higher risk for CV events (HR= 3.98, CI 1.74-9.10, p = .001 and all-cause mortality (HR=4.70, CI 1.7-12.97, p = . NIH Public Access Author ManuscriptHeart. Author manuscript; available in PMC 2009 December 1. Published in final edited form as:Heart . 2009 December ; 95(23): 1901-1906. doi:10.1136/hrt.2009. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript compared to those using neither medication. Kaplan Meier survival curves indicated that there was a significant difference in mortality among the four medication groups (p = .001).Conclusions-These data suggest that factors related to psychotropic medication such as depression refractory to treatment, or medication use itself, are associated with adverse CV events in women with suspected myocardial ischemia.

Objective: To determine the association between self-rated health and major cardiovascular events in a sample of women with suspected myocardial ischemia. Previous studies showed that self-rated health is a predictor of objective health outcomes, such as mortality. Method: At baseline, 900 women rated their health on a 5-point scale ranging from poor to excellent as part of a protocol that included quantitative coronary angiography, cardiovascular disease (CVD) risk factor assessment, cardiac symptoms, psychotropic medication use, and functional impairment. Participants were followed for a maximum of 9 years (median, 5.9 years) to determine the prevalence of major CVD events (myocardial infarction, heart failure, stroke, and CVD-related death). Results: A total of 354 (39.3% of sample) participants reported their health as either poor or fair. After adjusting for demographic factors, CVD risk factors, and coronary artery disease severity, women who rated their health as poor (hazard ratio, 2.1 [1.1–4.2]) or fair (hazard ratio, 2.0 [1.2–3.6]) experienced significantly shorter times to major CVD events compared with women who rated their health as excellent or very good. Further adjustment for functional impairment, however, attenuated the self-rated health relationships with major CVD events. Conclusions: Among women with suspected myocardial ischemia, self-rated health predicted major CVD events independent of demographic factors, CVD risk factors, and angiogram-defined disease severity. However, functional impairment seemed to explain much of the self-rated health association. These results support the clinical utility of self-rated health scores in women and encourage a multidimensional approach to conceptualizing these measures.