Women having heart attacks are less likely than men to get immediate treatment and more likely to die in the hospital, says a groundbreaking new study that tracked more than 1.1 million patients.
Women are less likely to get immediate treatment to stop the heart attack in its tracks: clot-busting drugs, balloon procedures to open the arteries or bypass surgery, the study says. Partly because of such delays, 15% of female heart attack patients die in the hospital, compared with 10% of men. Delaying care can be fatal. "Time is muscle," says study author John Canto of the Watson Clinic and Lakeland Regional Medical Center in Florida. "And muscle is life."
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The study actually may underestimate the gender gap, because many female heart attacks never make it to the hospital, says Cam Patterson, chief of cardiology at the University of North Carolina-Chapel Hill, who was not involved in the study.
Women are less likely to be properly treated, even when they have similar symptoms to men, according to the analysis in today's Journal of the American Medical Association, which included patients from 1994 to 2006.
In many cases, however, both doctors and patients may fail to realize the seriousness of the situation.
Forty-two percent of women never experience the classic heart attack symptom of chest pain or pressure, compared with 31% of men, the study says. That's especially true for women younger than 55, Canto says. In the short-term, heart attack patients without chest pain or discomfort are almost twice as likely to die as those who have that classic symptom, the study says.
Women without chest pain may develop shortness of breath, nausea, vomiting, light-headedness and pain in the back or jaw, according to the American Heart Association. Women who develop sudden, crippling fatigue - such as the feeling that they can't tidy the kitchen without a rest - may face imminent danger of a heart attack, says cardiologist Nieca Goldberg, medical director of NYU Langone Medical Center's Tisch Center for Women's Health.
Groups such as the American Heart Association have tried for years to educate women about these symptoms. The study suggests that, in spite of such campaigns, many women and their doctors fail to recognize these symptoms - or the need for immediate treatment, Goldberg says.
It's possible, Canto says, that there are genetic or biological reasons that make heart attacks in young women more lethal than attacks in older men. "If a young woman is premenopausal and she is experiencing a heart attack, something is seriously wrong," he says.
Canto says it's too early to change medical guidelines based on his study alone. He hopes other researchers will try to replicate his study, to see if his findings hold up. But several heart experts say the findings should be taken seriously.
"It's been sinking in to cardiologists for a while that women having heart attacks are more likely to have symptoms other than the classic chest pain syndrome that we see in the movies," Patterson says. "I was shocked, though, at how closely this was associated with worse outcomes and more cardiac death in women with heart attacks. This study makes me worried that we still don't get it."
Doctors or emergency responders may not take women's symptoms seriously, says Suzanne Steinbaum, director of women and heart disease at Lenox Hill Hospital in New York and an American Heart Association spokeswoman.
"Women are coming in saying they're nauseous, they're fatigued, they're sweating, and doctors say, 'You're fine,' " she says. "Doctors will say it's anxiety and it's all in your head."
Yet women also may not take their heart symptoms seriously enough, she says.
"We have a tendency to downplay what we're feeling," Steinbaum says. "If you say to your doctors, 'It's probably in my head,' then the person who is listening starts dismissing it. If you think you're having a heart attack, say it. And if you're wrong, then you're wrong."
Fewer than 20% of people who seek medical help for a heart attack are actually having one, Canto says.
Goldberg says both men and women should know their cholesterol levels, blood pressure and blood sugar . "We should use this study as an eye-opening bit of news to these women," she says. Because many young women never see a cardiologist, she says obstetrician-gynecologists could screen patients for heart disease by running simple tests and measuring patients' weights. That's especially important in light of new research, released last week, suggesting that pregnant women who develop gestational diabietes or a complication called pre-eclampsia have a much higher risk of later developing heart disease, Goldberg says.
"We are doing a miserable job of educating women about their risk of heart disease," Patterson says. "When I ask my wife what is she most afraid of, she says breast cancer. And yet she is six times more likely to die of a heart attack. We have a desperate message to share about the risk of heart disease in women of all ages."