Among patients hospitalized with a heart attack, women are more likely than men to present without chest pain and to die, although the difference between the sexes dwindles with increasing age, report researchers in an article appearing today in JAMA.
The study, which involved 1.4 million patients (42% of them women) who experienced a heart attack between 1994 and 2006 documented in the National Registry of Myocardial Infarction, revealed that more women (42.0%) with a heart attack presented to the hospital without chest pain compared with men (only 30.7%). In addition, 14.6% of women hospitalized with a heart attack died compared with 10.3% of men. The sex differences were most pronounced among those younger than 55 years and basically disappeared by age 75 years.
Lead author John G. Canto, MD, MSPH, director of cardiovascular prevention research and education at the Watson Clinic and director of Lakeland Regional Medical Center’s chest pain center in Lakeland, Fla, discusses his team’s findings:
“As presented in the media, chest pain is the hallmark symptom of heart attack. But many women, when compared with men, don’t present to the hospital with chest pain. We wanted to examine this gender difference in symptoms and subsequent mortality, after accounting for age.
“One of our findings is that women with heart attack are more likely to present with atypical symptoms than men, but this was most present in younger women under age 55. This difference markedly declines and disappears with increasing age. Our study cannot explain why there is gender difference, but 2 factors are at the forefront. The first factor is biological differences in a young woman with heart attack, such as hormonal differences. The second factor is that if we’re telling patients the classical symptom of heart attack—chest pain—and they lack it, then we should not be surprised that younger women with atypical symptoms delay getting to the hospital. And once they do present, the doctors may be unaware these women are having heart attack because they are young and have different presentations.
“Atypical symptoms are pain or discomfort in areas other than the chest, like the jaw, neck, shoulder, arms, and stomach. The other big atypical symptom is shortness of breath. For doctors, if you have a patient present with atypical symptoms, you should have on your radar screen that it may be a heart attack that needs to be confirmed with objective testing, starting with an EKG and a blood test to assess cardiac biomarkers.
“The current heart attack warning message is the same for men as for women today. Our results are provocative and challenge the conventional wisdom. If confirmed by different studies and databases, then we need to tailor the one-size-fits-all message to also include a message that younger women [in particular] may have different symptoms and their risk for dying is increased.”