Gender differences in pain characteristics of chronic stable angina and perceived physical limitation in patients with coronary artery disease

Abstract

Chronic stable angina pectoris, the chest pain associated with reversible myocardial ischemia has detrimental effects on health-related quality of life, particularly in women. The limited research on gender differences in chronic stable angina suggests that angina may be experienced differently in women and that women report greater functional disability related to angina symptoms. No studies have examined gender differences in chronic stable angina from a multidimensional pain perspective or have included reliable and valid measures of pain that would facilitate comparing chronic angina patients with other chronic pain populations. The purpose of this descriptive study was to examine gender differences in characteristics of chronic stable angina using the short-form McGill pain questionnaire (SF-MPQ) and to explore relationships among these pain characteristics and perceived limitation in performing physical activities in patients with coronary artery disease (CAD) (physical limitation subscale of the Seattle angina questionnaire). One hundred and twentyeight subjects (30.5% women) with stable CAD and angina pectoris documented by a cardiologist completed study questionnaires in an outpatient cardiology clinic. Results of the study suggest that men and women with chronic stable angina had more similarities than differences in chest pain characteristics. No significant gender differences were demonstrated in total sensory or affective intensity scores, the present pain intensity index, or the number of pain words chosen. However, women did report significantly greater pain intensity on the SF-MPQ visual analogue scale. Women were also significantly more likely to describe their chronic angina as 'hot-burning' and 'tender' and to have greater intensity of pain for these two descriptors. Despite the similarities in pain characteristics, women reported greater physical limitation related to anginal pain. The variables of social status and years diagnosed with CAD significantly interacted with gender in predicting physical limitation suggesting that gender-specific models of physical limitation in angina patients need to be explored. To our knowledge, this is one of the first studies that has assessed chronic anginal pain using a reliable and valid generic pain instrument. More research is needed to better understand the nature of gender differences in functional limitation secondary to anginal pain and the physiologic, cognitive-perceptual and psychosocial mechanisms that lead to angina-related functional disability.

Angina Symptoms Are Associated With Mortality in Older Women With Ischemic Heart Disease

“…13,14 A previous study that used the SAQ in a mixed population of men and women showed that compared with men, women reported greater physical limitation related to angina pain. 7 The aim of the present study was to investigate the association between angina symptoms and mortality in older women. Angina symptoms were assessed with SAQ scores for physical limitation, angina frequency, angina stability, and disease perception.…”

“…Although IHD-related death rates for men and women are comparable, there are significant gender differences in the presentation and prognoses of IHD. [1][2][3][4][5][6][7][8][9][10] Compared with men, women are more likely to present with angina and less likely to present with recognized or unrecognized myocardial infarction. 1 Women with IHD have lower pain thresholds and report more frequent chest pain during daily life than men, 6 but among patients presenting with angina, women are less at risk than men for myocardial infarction and overall mortality.…”

A comprehensive view of sex-specific issues related to cardiovascular disease

“…[262][263][264]266,273,293,295 Ryan and colleagues 296 found that patients, namely older adults and women, presenting with atypical symptoms including chest pain in areas other than substernum or left side or no chest pain, often had delayed diagnosis, less-aggressive treatment and higher rates of in-hospital mortality. Similarly, Boccardi and Verde's review 265 of gender differences in clinical presentation to the emergency department for chest pain found that women with ACS were older and had a higher prevalence of diabetes and hypertension, longer delays from symptom onset to presentation and higher in-hospital mortality compared with men.…”

“…The fact that 69% of women initially presenting with angina compared with 30% of men, 264 combined with data that suggest that women with ACS experience more "atypical" symptoms, [262][263][264]266,273,293,295 means that fewer women with ACS are studied, and there is a lack of understanding as to whether the sex-gender differences in prodromal and presenting symptoms of ACS are significant enough to require change in clinical practice.…”

Stroke and Myocardial Infarction: A Comparative Systematic Evaluation of Gender-Specific Analysis, Funding and Authorship Patterns in Cardiovascular Research

“…Women and men are affected at different ages, differ in their coronary pathophysiology [4] and have different likelihood to die early after hospitalization for a first myocardial infarction (MI) [5]. Both genders perceive and describe chest pain and the symptoms of cardiac ischemia in different ways, which leads to differences in time from onset to seeking medical advice as well as potential differences in diagnosis, treatments and outcomes [6,7]. However, sex and gender as determinants of clinical presentation, medical service provision and outcomes have been scarcely incorporated into research practice and are still only marginally addressed [8,9,10,11].…”