Healthy Living News

Women Have Less Chest Pain, More Deaths

by Howard LeWine, M.D.
Harvard Medical School

Not only are women with heart attacks less likely to have chest pain than men, but those without this symptom are more likely to die, a new study finds. The difference was especially strong among younger women. Recent research has shown that women and men may have different heart attack symptoms. The new study provided more information. It used records from 1.1 million heart attack patients. They were seen at U.S. hospitals between 1994 and 2006. About 42% of women and 31% of men did not have chest pain or pressure. Nearly 15% of women died in the hospital, compared with 10% of men. The average woman having a heart attack was 74, compared with 67 for men. But younger women, under age 65, were 24% to 30% more likely to die in the hospital than men the same age. Both men and women were more likely to die if they did not have chest pain. Among those without chest pain, younger women had higher death rates than younger men. This difference disappeared by age 65. The Journal of the American Medical Association published the study February 22. USA Today, HealthDay News and MedPage Today wrote about it.

What Is the Doctor's Reaction?

We all know how different women are from men. This goes for symptoms of a heart attack as well as so many other things.

Classic symptoms of coronary heart disease are:

• Crushing, pressure-like pain in the middle of the chest
• Pain radiating down the left arm and up to the jaw
• Sweating
• Shortness of breath

But new research shows us that 30% of men and more than 40% of women don't have these symptoms. This is especially true for younger women. Women younger than 65 are quite likely to have what doctors call "atypical" symptoms.

Women are more likely than men to have symptoms unrelated to chest pain. They include:

• Shortness of breath
• Sudden weakness or fatigue
• A cold sweat
• Dizziness
• Nausea or indigestion
• Aching or heaviness, or weakness in one or both arms
• Palpitations (an irregular or racing heart beat)

The problem for women is that most often these symptoms are not related to a heart attack. So women will tend to not seek medical care right away. The delay in getting to the hospital may be one of the reasons that women are more likely to die in the hospital from a heart attack than men.

Also, doctors use chest pain as the key symptom to trigger a rapid heart attack diagnosis. Without chest pain, other diagnoses are often considered first. Anything that delays starting treatment for a heart attack increases the risk of more heart damage.

What Changes Can I Make Now?

Quitting smoking is the most important change you need to make. Most heart attacks in younger women occur in smokers.

The findings emphasize the importance of knowing your personal heart risk profile. Having any of these factors increases your risk:

• A family history of coronary artery disease, especially before age 65
• A large waist size
• High blood pressure
• A high LDL (bad) cholesterol
• A low HDL (good) cholesterol
• A high fasting blood sugar

In general, the goals will be to:

• Lower blood pressure, shooting for 120/80 or less
• Lower LDL cholesterol (100 or less is best)
• Lower triglycerides (under 150)
• Raise HDL cholesterol (greater than 50)
• Lower fasting blood sugar (under 110)

These changes can help you to reach the goals.

• Exercise for at least 30 minutes daily, preferably 60 minutes.
• Eat a healthy diet loaded with vegetables. (Remember, potatoes don't count.)
• Take in only as many calories as you burn off each day to maintain a healthy weight.

If you have any factors that increase your risk of heart disease, work with your doctor to see if more than just lifestyle changes are needed. Have this discussion even if you feel fine.

What Can I Expect Looking to the Future?

We now know that many women with a heart attack won't have typical chest pain. But the main message about heart attack must remain centered on this symptom. If you have new and unexplained chest pain, call 911.

There is no simple message about the many other symptoms of heart disease. If you have heart disease risk factors, new "atypical" symptoms should prompt an immediate call for medical advice.

Categories: Women's Health, Stroke, Heart Health

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