Study: Women Twice as Likely to Die of Most Serious Type of Heart Attack
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Reviewed By Elizabeth Klodas, MD, FACC
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Dec. 8, 2008 -- Women hospitalized for the most serious type of heart attack are more than twice as likely as men to die, a new study shows.
Researchers examined treatments and outcomes among men and women hospitalized for heart attacks (also referred to as myocardial infarctions) in an effort to determine the extent of widely reported gender disparities.
After adjusting for the fact that the female heart attack patients tended to be older and sicker than the males, the researchers found no overall difference in mortality between the two groups.
But the in-hospital death rate among women who had ST elevation myocardial infarctions (STEMI), which kill more people than any other type of heart attack, was nearly twice that of men -- 10.2% compared with 5.5%. A STEMI-type heart attack is characterized by a specific pattern on an EKG and is usually caused by a sudden, complete blockage of one of the heart arteries.
Many of the deaths occurred in the first 24 hours of hospitalization. During this period, women were less likely than men to receive commonly used treatments such as angiograms and heart bypass surgery.
"There is good news and bad news in our findings," lead author and cardiologist Hani Jneid, MD, of the Baylor College of Medicine, tells WebMD.
"Overall, we are doing a better job than we were a decade ago recognizing and treating heart attacks in women, and mortality rates are better because of this," he says. "But for the most severe type of heart attack, there is still a gap between men and women."
Jneid and colleagues examined the in-hospital medical records of more than 78,000 heart attack patients treated at 420 U.S. hospitals between 2001 and 2006.
On average, the women were eight years older than the men at the time of their heart attacks (age 72 compared to 64), and they were more likely to have heart-related health problems such as diabetes, heart failure, and high blood pressure.
After adjusting for these differences, the researchers found no difference by sex in the overall heart attack death rate, even though women in general got fewer of the recommended treatments than men. Among other findings, women were less likely to receive recommended medications and clot-busting treatments upon arrival at the hospital, and were less likely to undergo immediate angioplasty.
Among the patients who had STEMI events, the increase in death rates in women appeared to be almost entirely related to higher mortality within the initial 24 hours of hospitalization. Although the factors contributing to this are likely multiple, the authors point to the lower use of recommended therapies early during hospitalization as a potential area for improvement in the care of female heart attack patients.
The study appears in the latest issue of Circulation: The Journal of the American Heart Association.
Symptoms Often Subtle
Unlike men, many women don't experience severe, crushing chest pain when they are having a heart attack. Their symptoms are often much less obvious, and this can lead to delays in seeking help and in diagnosis and treatment, study co-author and UCLA professor of cardiovascular medicine Gregg C. Fonarow, MD, tells WebMD.
"Any woman who suspects she is having a heart attack needs to call 911 immediately," he says.
Recognize the Signs
So when should a woman suspect she is having a heart attack?
WebMD asked two NYU Medical Center cardiologists who specialize in treating women: Nieca Goldberg, MD, and Jennifer Mieres, MD.
The classic symptoms like chest pain, back pain, and/or deep-aching arm pain should raise suspicions. But other common symptoms include:
- Extreme shortness of breath. "Feeling like you've run a marathon when you've barely exerted yourself at all," Goldberg says.
- Clamminess and sweating.
- Dizziness, unexplained lightheadedness, and even blackouts.
- Unshakable extreme anxiety.
- Nausea or other gastric upset.
Whether you experience all of these symptoms or just a few, Goldberg says one way to recognize a heart attack is that the symptoms will be relentless.
"Nothing that you do will make them go away," she says. "That's when you know it's time to call 911."
Both doctors agree that anyone who suspects they may be having a heart attack should get to a hospital and have an electrocardiogram (EKG) immediately.
Although the STEMI event is the most deadly heart attack, it is also the easiest to diagnose with an EKG, Goldberg says.
"This is no time to be shy," says Mieres, a spokeswoman for the American Heart Association.
"The first thing you should say is, 'I think I'm having a heart attack.' Those are the magic words that should get you an EKG," she says.
Time is of the essence when you are having a heart attack. Seeking and receiving medical help quickly can make the difference between life and death.
SOURCES: Jneid, H., Circulation, Journal of the American Heart Association, Dec. 16/23, 2008; online. Hani Jneid, MD, assistant professor of Cardiovascular Medicine, Baylor College of Medicine, Houston. Gregg C. Fonarow, MD, professor of cardiovascular medicine, University of California at Los Angeles Medical Center. Nieca Goldberg, MD, cardiologist, clinical associate professor, New York University School of Medicine. Jennifer Mieres, MD, director of nuclear cardiology, New York University School of Medicine; spokeswoman, American Heart Association.
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