As physicians, we’ve known for years that heart attacks in women can be very different than those in men. Many women present with non-traditional symptoms — like jaw or shoulder pain — or no symptoms at all. There are differences in the causes and types of heart attacks that women experience, differences in how they’re treated and even differences in their outcomes.
For years, those differences were reported in a variety of studies, but never compiled in one place so health care providers could see the impact heart attacks have on women. Though heart disease kills more women each year than men — and has since 1984 — for too long we have not sufficiently acknowledged the role one’s sex plays in heart attacks.
Fortunately, that’s changed. The American Heart Association recently published a scientific statement on heart attacks in women in the online edition of the journal Circulation. This statement compiles the nuances women experience in the course of a heart attack and will serve as a go-to reference for physicians and health care workers going forward.
You can read the entire 32-page statement here, but I want to take this opportunity to share with women at least some of the information they need to know when it comes to heart attacks.
First, let’s start with a woman’s risks. Both men and women are at a higher risk of having heart attacks due to things like high blood pressure, obesity and high cholesterol.
But it might surprise you to know that certain risk factors are more potent in women, like diabetes, depression and the use of tobacco. In fact, smoking increases a woman’s risk of having a heart attack seven-fold and is the leading cause of heart attacks in women under the age of 55.
We’re still not sure exactly why these risk factors tend to be more dangerous in women, but the good news is all of them can be identified and treated before they lead to heart disease.
Women also differ in the types of symptoms they suffer during a heart attack. The most common symptom in both sexes is pain or discomfort in the chest. However, only about half of all women have chest pain.
Women can suffer pain in the upper back, arm, neck or jaw, and often report subtle and nonspecific symptoms. During a heart attack, a woman may experience unusual fatigue, indigestion, shortness of breath or flu-like symptoms. The danger is that these symptoms are shared by many other less-serious conditions, and treatment is often delayed because women dismiss their severity.
Another factor that can delay treatment is the timing of a woman’s symptoms. Unlike the sudden and dramatic onset of symptoms often associated with a heart attack, many women reported more nuanced symptoms that appear, pass and recur. In some cases, the symptoms build over several days or even months before the heart attack.
The types of heart attacks women have can differ from men as well. While the majority of men suffer heart attacks caused by severe arterial blockage, women can have milder blockages, and they can be hard to detect with traditional testing. Women can also have heart attacks caused by intense spasms of the heart arteries.
Another type of heart attack women experience more frequently than men is spontaneous coronary artery dissection, in which the wall of an artery suddenly tears, causing a massive heart attack. These occur most often in younger, seemingly healthy people, and current research is focusing on hormonal issues that may put women at a higher risk.
Lastly, women need to understand that they lag far behind men when it comes to heart attack recovery. Cardiac rehabilitation has been shown to vastly improve the health and quality of life of heart attack survivors. But over the last 30 years, cardiac rehab has failed to reach more than 80 percent of women who are eligible. Simply put, even if women survive a heart attack, they’re not likely to get the support they need to more completely recover. This has to change.
As the director of the Women’s Cardiovascular Health Program at The Ohio State University Wexner Medical Center, I was honored to chair this effort and help write the statement, along with many exceptional colleagues across the country.
We’ve seen a dramatic reduction in the number of deaths from cardiovascular disease in women over the last decade, but we have more work to do. Hopefully, this statement — the first collection of female-specific data of its kind — will make women more aware of the unique risks and symptoms they face when it comes to heart attacks, and make doctors more prepared to treat them.
Laxmi Mehta, MD, is director of the Women’s Cardiovascular Health Program and Assistant Professor of Clinical Medicine at The Ohio State University Wexner Medical Center.
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Heart Attacks Are Different in Women — and It’s Time We Treat Them That Way originally appeared on usnews.com
