The presentation of angina symptoms in women is so variable that it carries a poor predictive value when evaluated for chest pain. Because of this, women who present with chest pain tend to receive less aggressive and delayed treatment for coronary artery disease (CAD) compared with men. Previous studies have shown a relationship between psychologic factors, such as high anxiety and life stress, and chest pain in women. No studies describing this link have objective data on the presence of CAD. Rutledge and colleagues hypothesized that women with chest pain and a prior history of anxiety disorders were less likely to have angiographic CAD than women with chest pain and no prior history of anxiety disorders.

Women were eligible for the multicenter trial (Women's Ischemia Syndrome Evaluation) if they were referred for coronary angiography because of chest pain or suspected coronary ischemia. A total of 435 women underwent a diagnostic protocol including coronary angiography and completed questionnaires assessing their current anxiety-related symptoms and their treatment history for anxiety disorders. The analysis of the data was controlled for the standard risk factors for CAD.

About 10 percent of the women enrolled in the study reported having received treatment for anxiety disorders before the study. This group also reported a higher incidence of autonomic symptoms such as headache and muscle tension and had higher behavior avoidance scores when compared with the remainder of the study participants. The women with a prior history of anxiety disorders also were more likely to report tight and sharp chest pain than those in the control group, and to experience back pain and nocturnal chest pain. Analysis comparing the two groups revealed that the group with a prior history of anxiety was less likely to have significant angiographic CAD than the group that did not have an anxiety-related history.

Chest pain symptoms are less reliable markers for CAD in women than in men. This was found to be true in a previous study in which 35 percent of the women who were referred for chest pain or coronary ischemia had no evidence of CAD and another 25 percent had only modest evidence of nonobstructive CAD.

The authors conclude that their study suggests that anxiety characteristics in women with chest pain are associated with a lower probability of significant CAD. In addition, women with a positive history for anxiety disorders expressed more severe clinical symptoms. When assessing women with chest pain, the history of an anxiety disorder may assist in identifying patients who are at low risk for CAD.