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MONDAY, Aug. 21 (HealthDay News) -- Chest pain isn't cheap.

A new U.S study finds that the lifetime bill for treating a woman's heart disease-linked angina could total $1 million.

Even chest pain associated with "mild" artery blockages -- called nonobstructive coronary artery disease -- could top $750,000 or more per woman over her lifetime, the researchers found.

"I was really astounded," said Leslee J. Shaw, professor of medicine at Emory University, Atlanta, the lead author of the study. "We went into this thinking it was $300,000 over a lifetime, that was the figure that was previously guess-timated."

Her team published its findings in the Aug. 22 issue of Circulation.

According to Shaw, the study's aim was to provide health care administrators with data that would help them better allocate scarce health care resources -- especially for female patients who might need more interventions.

The figures include medical care, plus an estimate of indirect costs to society linked to heart disease: lost work hours, transportation costs and out-of-pocket costs for drugs and alternative therapies.

The findings shouldn't dissuade women from seeking out care when chest pain strikes, however.

"Women should not take this as something to scare them off from getting evaluated [due to the cost]," said Dr. Nieca Goldberg, chief of women's cardiac care at Lenox Hill Hospital in New York.

Shaw and her colleagues evaluated 883 women referred for coronary angiography (a specialized X-ray exam of the coronary arteries). All were part of the Women's Ischemia Syndrome Evaluation (WISE) study.

That study -- begun in 1996 and sponsored by the U.S. National Institutes of Health -- has produced numerous reports focused on women and heart disease.

Shaw's team compared data on the women's health, their personal finances and their quality of life over a period of at least five years.

Of the total, 62 percent had non-obstructive coronary artery disease, defined as blockage of less than 50 percent of the vessel. Seventeen percent had one vessel either blocked or narrowed, and 11 percent had two vessels narrowed. Ten percent had three affected vessels.

Shaw's group found that nearly two-thirds of the women had heart disease, but that they had no significant vessel narrowing and so weren't considered "high-risk." But her group assumed that these women wouldn't have as many medical needs as women with blockages of one or multiple vessels. They were incorrect, however, and found that medical bills steadily mounted for this group, as well.

The reason, they concluded, was ongoing angina, which can occur when the heart does not get enough blood and oxygen. This drove these otherwise "low-risk" women back to the doctor for help.

At the one-year mark, Shaw's team found, the number of repeat angiograms or hospitalizations for chest pain was 1.8 times higher in those with nonobstructive heart disease as in those with one vessel obstructed.

At the five-year mark, 20 percent of women with nonobstructive heart disease had been hospitalized for chest pain, while 55 percent of those with three-vessel disease had been hospitalized.

Women with either nonobstructive or one-vessel heart disease also had the highest drug treatment costs. Drugs to improve blood flow to the heart made up nearly 15 percent of total costs in those with nonobstructive disease and about 12 percent to 14 percent of total health care costs for women with obstructive disease.

Out-of-pocket costs for health care over the five years of the study totaled more than $32,000 for female patients with nonobstructive disease and more than $53,000 for those with three affected vessels.

Lifetime costs for women with obstructive disease were estimated at $1 million, while women with nonobstructive disease racked up bills of over $750,000, the study concluded.

"Many of these women didn't have prescription drug coverage, so they were paying for these very expensive drugs out-of-pocket," Shaw said.

Overall, Shaw noted in the study report, health care costs for coronary heart disease in the United States now total $368.4 billion.

The message to women is clear, said Goldberg. "The time to get symptoms evaluated is when you first start to feel them." Early intervention can help improve prognosis while holding down costs, she said.

"We need to put more value on prevention," she added. "Right now, we [doctors] are focusing on high-technology tests." Doctors should focus more on the patients as people, she said, and listen closely to their symptoms to better decide which tests are needed.

"Patients need to be proactive," Shaw added. A woman who can't afford the out-of-pocket costs of prescribed drugs, she said, should consider asking her doctor to help her find out about subsidized drug programs that might be available.

More information

To learn more about women and cardiac health, visit the U.S. National Heart, Lung, and Blood Institute.

THURSDAY, Aug. 24 (HealthDay News) -- Botox injections can help facial wounds heal with less scarring, a small study finds.

"This is the first medication found to minimize scarring," senior author Dr. David Sherris, professor and chair of the department of otolaryngology at the University at Buffalo, said in a prepared statement.

His team published the study in the August issue of Mayo Clinic Proceedings.

The study included 31 patients who suffered wounds to the forehead or had surgery to remove skin cancers from the forehead, an area that's particularly susceptible to scarring. The patients received either an injection of Botox or saline within 24 hours after wound closure.

Photographs were taken at the time the patients received the injections and again six months later. The photographs were reviewed by two facial plastic surgeons who weren't involved in the study. They rated the patients' wound healing on a scale of zero to 10, with 10 representing the best result. The two surgeons' scores were averaged to reach a final score for each patient.

The median scores for wounds injected with Botox were 8.9, compared to 7.1 for wounds injected with saline.

"The result is of substantial interest in the field of scar treatment. When a wound occurs, especially on the face, people are always worried about the scar. We can now try to improve scars with these injections," Sherris said.

The study was funded by a clinical research grant from the Mayo Clinic.

More information

The American Society of Plastic Surgeons has more about scars  .

THURSDAY, Aug. 24 (HealthDay News) -- Two widely used antidepressants, nortriptyline and Zoloft (sertraline), are safe and effective for treating postpartum depression, a new study finds.

The University of Pittsburgh study is one of the first to compare the effectiveness of two classes of antidepressants -- a selective serotonin reuptake inhibitor (Zoloft) and a tricyclic (nortriptyline) -- in treating the common, debilitating condition.

"We've been treating postpartum depression based on the assumption that drugs that work for a woman with depression under usual circumstances, will work for a women who experiences depression after giving birth, but there have not been studies that provide scientific proof that this was an effective and safe course of treatment," Dr. Katherine L. Wisner, professor of psychiatry and obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine, said in a prepared statement.

The study started with 109 participants, randomly selected to take either nortriptyline or Zoloft. Of those 109 women, 95 provided response data at four weeks, 83 provided data at eight weeks, and 29 completed between 20 and 24 weeks of the study.

Both drugs produced similar results.

By week four, 46 of the participants taking Zoloft had responded with a reduction in depressive symptoms and 27 percent had remitted (few depressive symptoms), while 56 percent of those taking nortriptyline responded and 30 percent remitted.

Of the 29 women who remained in the study until 20 to 24 weeks, 93 percent taking Zoloft responded and 73 percent remitted, while 100 percent taking nortriptyline responded and 79 percent remitted.

Both drugs produced similar improvements in psychosocial functioning, and neither drug was superior to the other in treating aggressive obsessional thoughts, the study said.

The findings were published in the August issue of the Journal of Clinical Psychopharmacology.

The Zoloft used in the study was donated by the drug's maker, Pfizer, but the drug company did not provide any direct financial support for the study, which was funded by the U.S. National Institutes of Health.

Wisner is a member of Pfizer's speaker's bureau and has a grant from Pfizer to study one of its other products. Wisner is also a member of the speaker's bureau for GlaxoSmithKline.

More information

The American Psychiatric Association has more about postpartum depression  .

THURSDAY, Aug. 24 (HealthDay News) -- The emergency contraceptive Plan B, often referred to as the "morning after" pill, was approved by the U.S. Food and Drug Administration on Thursday for over-the-counter sale to women aged 18 and older.

Younger women and girls will still need a prescription for the drug, which contains higher doses of an ingredient found in prescription birth control pills. Designed to prevent pregnancy if taken within 72 hours of unprotected sex, it's been available with a prescription in the United States since 1999.

Barr Pharmaceuticals' Duramed subsidiary will make over-the-counter Plan B available "with a rigorous labeling, packaging, education, distribution, and monitoring program," the FDA said in a statement. Distribution will only be available through licensed drug wholesalers, pharmacies, and clinics to prevent unauthorized non-prescription sales to those under age 18, the statement added.

Barr originally applied to the FDA for over-the-counter sales of Plan B to females of any age, but the agency rejected that plan, saying it didn't have enough evidence that the drug could be used effectively and safely by females under age 18 without a medical professional's supervision.

More information

To learn more about Plan B, check this FDA Questions and Answers page.