According to the Los Angeles County Department of Public Health, coronary heart disease is the leading cause of death and premature death for women in the county. It has long been known that women, compared to men, more commonly do not experience chest pain when suffering a heart attack; however, the data is for older women. To clarify the situation for younger women, Canadian researchers conducted a study on this age group. They published their findings online on September 16 in the journal JAMA Internal Medicine.
The purpose of the study was to evaluate sex differences in acute coronary syndrome (ACS) presentation and to estimate associations between sex, sociodemographic, gender identity, psychosocial and clinical factors, markers of coronary disease severity, and absence of chest pain in young patients with ACS.
The researchers conducted a prospective (forward looking) study of 1,015 patients (30% women) 55 years or younger, hospitalized for ACS and enrolled in the GENESIS PRAXY (Gender and Sex Determinants of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary Syndrome) study (January 2009 through September 2012). The main outcome measure was determined by the administration of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey during hospitalization.
The average age for both sexes was 49 years. Compared to men, women were more likely to have an electrocardiogram (EKG) finding known as a non–ST-segment elevation myocardial infarction and present without chest pain. Patients without chest pain reported fewer symptoms overall and no identifiable pattern of non–chest pain symptoms was found. Using statistical analysis, the researchers found that being a woman and having tachycardia (rapid heartbeat) were both associated with ACS presentation without chest pain. Patients without chest pain did not differ significantly from those with chest pain in terms of ACS type, coronary stenosis (narrowing of the coronary arteries), or troponin level elevation. (The troponin test measures the levels of certain proteins called troponin T and troponin I in the blood. These proteins are released when the heart muscle has been damaged, such as a heart attack.)
The authors concluded that chest pain was the most common ACS symptom in both sexes. Women were more likely to present without chest pain than men; however, absence of chest pain was not associated with markers of coronary disease severity. They recommended that strategies that explicitly incorporate assessment of common non–chest pain symptoms need to be evaluated.
Take home message:
This study clarifies that women of all ages may not have the typical chest pain symptoms of a heart attack, which are: (1) Severe pressure, fullness, squeezing, pain and/or discomfort in the center of the chest that lasts for more than a few minutes; (2) Pain or discomfort that spreads to the shoulders, neck, arms, or jaw; (3) Chest pain that increases in intensity; or (4) Chest pain that is not relieved by rest or by taking nitroglycerin. However, they may experience one of more of the following symptoms: (1) Sweating, cool, clammy skin, and/or paleness; (2) Shortness of breath; (3) Nausea or vomiting; (4) Dizziness or fainting; and/or (4) Unexplained weakness or fatigue.
Individuals suffering a heart attack often present at a hospital’s emergency department (ED) for care. Unfortunately, the majority of patients presenting at an ED do not have a serious health problem; thus, it is a challenge for healthcare professionals to determine which patients are seriously ill. For example, chest pain can be due to ingestion or a lung infection. The situation is likely to worsen as implementation of the Affordable Care Act evolves. Thus, if you or a loved one experiences the aforementioned symptoms, it is prudent to inform ED staff that you suspect a heart attack and want it checked out. Prompt intervention is essential for increasing the chance of a good outcome when suffering a heart attack.
Certain genetic (inherited) and acquired factors increase the risk of a heart attack.
- People with inherited hypertension (high blood pressure)
- People with inherited low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol or high levels of triglycerides
- People with a family history of heart disease (especially with onset before age 55)
- Aging men and women
- People with type 1 diabetes
- Women, after the onset of menopause (generally, men are at risk at an earlier age than women, but after the onset of menopause, women are equally at risk)
Acquired risk factors:
- People with acquired hypertension (high blood pressure)
- People with acquired low levels of HDL (high-density lipoproteins), high levels of LDL (low-density lipoprotein) blood cholesterol, or high levels of triglycerides
- Cigarette smokers
- People who are under a lot of stress
- People who drink too much alcohol
- People who lead a sedentary lifestyle
- People overweight by 30% or more
- People who eat a diet high in saturated fat
- People with type 2 diabetes