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Cardiologists initiate STILETTO study to investigate treatment options for women with chest pain

CHICAGO Women who experience chest pain are sent to a cardiologist to go through a standard battery of tests, and often times test results show no evidence of coronary artery disease which is the most common cause of chest pain. This is a less common occurrence in men, and these women are sent home with little more than reassurance but often times return to their physicians complaining of similar symptoms and are more likely to develop future cardiac events.

To better determine the cause of difficult to diagnose chest pain among women, physicians at Northwestern Memorial's Bluhm Cardiovascular Institute are initiating a research study designed to identify the prevalence of a condition called Syndrome X. This disease process affects the endothelial function of blood vessels, a condition where the layers of the cells are not functioning properly and may be undetectable by standard testing such as exercise stress test and cardiac angiography. Researchers believe that endothelial dysfunction is the earliest stage of coronary artery disease. The goal of the study is to determine a more accurate diagnosis for women who present with chest pain symptoms and to determine if a more aggressive treatment regimen than the current standard of care may be adopted in the future.

In women there may be a different disease process which could be due to endothelial dysfunction, which is not something that can be detected by the current standard of care regimen. "Given that endothelial dysfunction may be an early stage of atherosclerosis, or fat deposits in the arteries, some have suggested medical treatment and lifestyle changes similar to those recommended to women with obstructive coronary artery disease," says Martha Gulati, MD, associate medical director of the Center for Women's Cardiovascular Health and assistant professor of medicine at Northwestern University's Feinberg School of Medicine.

"There are currently no other randomized trials comparing the effectiveness of such therapy in women with cardiac symptoms, normal coronary arteries but evidence of coronary endothelial dysfunction," commented Neil Stone, MD, medical director of the Center for Vascular Disease and professor of medicine at Northwestern University's Feinberg School of Medicine.

Study participants will undergo endothelial dysfunction testing, a procedure where medication is injected into the coronary arteries to directly assess endothelial response of the arteries, in order to identify women who may be likely to develop coronary artery disease and who would benefit from aggressive lifestyle and medical interventions. These interventions include dietary counseling, exercise, and medical treatment targeting improving the endothelial dysfunction.


Contact: Amy Dobrozsi
Northwestern Memorial Hospital

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