Being aware of differences in how the disease shows up in women may help doctors diagnose transthyretin amyloid cardiomyopathy (ATTR-CM) earlier in female patients, according to a recent review published in the journal Cardiology and Therapy.
ATTR-CM happens when a protein called transthyretin folds the wrong way and builds up in the heart muscle. This makes it hard for the heart to pump blood.
For a long time, doctors thought of ATTR-CM as a disease that mostly happened to men. But more and more studies show it may be missed in women. One big reason is that the disease can look different in women than it does in men.
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One of the most important warning signs involves the thickness of the heart’s wall. Doctors often decide to test someone for ATTR-CM when the left ventricle’s wall is 12 mm thick or more. But women with the disease often have thinner heart walls than men. This means they may not reach that number, even when the disease is seriously affecting their heart. As a result, ATTR-CM in women can be missed during testing.
Hormone differences between men and women may also change how the disease shows up in the heart, leading to different patterns in women compared with men. “Female patients with increased left ventricular (LV) wall thickness are often post-menopausal and older, indicating that hormonal transitions may affect disease onset,” the study’s authors said.
Read more about ATTR-CM testing and diagnosis
Socio-economic challenges can add to the problem. Women often spend more time caring for others, may have their symptoms brushed off by doctors and may have less money to pay for medical care. Because of all this, some women wait several years before they are finally diagnosed.
Updating screening guidelines and raising awareness in the community could help doctors catch the disease in women earlier, the review’s authors said.
They also note that research studies should put more focus on women with ATTR-CM. “Given the historical underrepresentation of women in clinical studies on ATTR-CM, further investigation is necessary to better understand the prevalence, treatment efficacy, and outcomes of ATTR-CM in women,” the review’s authors said.
