Heart Attack Causes and Symptoms Differ in Women

American Heart Association identifies gender disparities

A woman’s heart attack may have different underlying causes, symptoms, and outcomes compared with men, and differences in risk factors and outcomes are further pronounced in black and Hispanic women, according to a scientific statement from the American Heart Association (AHA).

The statement, published in Circulation, notes that there have been dramatic declines in cardiovascular deaths among women because of improved treatment and prevention of heart disease as well as increased public awareness. However, despite these improvements, heart disease remains underdiagnosed and undertreated in women, especially African-American women, according to writing group chair Laxmi Mehta, MD, of Ohio State University.

Women face greater complications from attempts to restore blood flow because their blood vessels tend to be smaller and because they are older and have increased rates of risk factors, such as diabetes and hypertension, according to the AHA statement. Guideline-recommended medications are consistently underused in women, leading to worse outcomes. Moreover, cardiac rehabilitation is prescribed less often for women, and even when it is prescribed, women are less likely to participate in it or complete it.

While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms, such as shortness of breath, nausea or vomiting, and back or jaw pain.

Risk factors for heart attacks also differ in the degree of risk in men compared to women, according to the AHA. For example, hypertension is more strongly associated with heart attacks in women, and if a young woman has diabetes, her risk for heart disease is four to five times higher compared with that of young men.

The AHA further states that, compared with white women, black women have a higher incidence of heart attacks in all age categories, and that young black women have higher in-hospital death rates. Black and Hispanic women tend to have more heart-related risk factors, such as diabetes, obesity, and hypertension, at the time of their heart attack compared with non-Hispanic white women. Compared with white women, black women are also less likely to be referred for important treatments, such as cardiac catheterization.

Understanding gender differences can help improve prevention and treatment among women, Mehta said. “Women should not be afraid to ask questions –– we advise all women to have more open and candid discussions with their doctors about both medication and interventional treatments to prevent and treat a heart attack,” she remarked.

“Coronary heart disease afflicts 6.6 million American women annually and remains the leading threat to the lives of women. Helping women prevent and survive heart attacks through increased research and improving ethnic and racial disparities in prevention and treatment is a public health priority,” Mehta said.

Sources: American Heart Association; January 26, 2016; and Circulation; January 26, 2016.