February 22, 2012
Women’s Heart Attack Symptoms Result In Treatment Delays, Higher Risk Of Death
Women are less likely than men to seek medical help when having a heart attack, and are more likely to die in the hospital, according to a new study published Tuesday in the Journal of the American Medical Association.
The study, which tracked more than 1.1 million patients, found that women — particularly younger women — were less likely to arrive at the hospital with chest pain or discomfort following a heart attack.
Those symptoms, or lack of symptoms, can result in delayed medical attention and differences in treatment that could explain why women were also more likely to die of their heart attacks, the researchers said.
"They might not even know they're having a heart attack," said Dr. John Canto of the Watson Clinic in Lakeland, Florida, who worked on the study.
While the findings challenge the idea that chest pain and discomfort are hallmark symptoms for all heart attack patients, the results of the study are still preliminary, Dr. Canto cautioned.
"If our results are in fact true, I would argue that rather than the one-size-fits-all symptom message, we also have to tailor that message to say that women less than 55 are also at higher risk for atypical presentation," Dr. Canto said in an interview with Reuters.
These symptoms can include jaw or arm pain, he said.
The researchers reviewed medical records in a national database of heart attack patients from 1994 to 2006, including 1.1 million people treated at 2,000 hospitals. They found that 31 percent of male patients did not report having any chest pain or discomfort, while 42 percent of the female patients lacked these symptoms.
The odds of having this type of atypical presentation differed most between younger women and younger men, the researchers said.
Women under 45 were 30 percent more likely than men of equal age to present without chest pain. Between the ages of 45 and 65 the difference fell to around 25 percent, and after the age of 75 the difference virtually disappeared.
A similar pattern, with smaller differences between sexes, was observed in the likelihood of death, with nearly 15 percent of women dying in the hospital following their heart attack, compared to about 10 percent of men. Younger women without chest pain were nearly 20 percent more likely to die than their same-age male counterparts. However, after age 65, the women's risk fell below that of men.
Women tend to be, on average, seven years older than men when they suffer their first heart attack.
"Young women shouldn't be having heart attacks, so when a young woman has a heart attack, there's something biologically different in that patient," Dr. Canto said, adding that the biological differences may include variations in hormone levels or in the way blood clots form in younger women.
Rather than having chest pain, some people having a heart attack may have unexplained shortness of breath, or pain in the jaw, neck, arms, back and stomach, Dr. Canto explained.
Women, particularly those predisposed to heart attacks due to family history, diabetes, or smoking habits, should be aware that a lack of chest pain does not exclude the possibility of a heart attack, he noted.
About 800,000 Americans have their first heart attack every year, according to figures from the U.S. Centers for Disease Control and Prevention.
The study was published online February 21, 2012 in the Journal of the American Medical Association.
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