Women's heart attacks are different, deadlier

Meliah Jefferson, 36, of Greenville, S.C., and Julie Rickman, 46, of Overland Park, Kan., have a lot in common. Each has a husband, a young child, a good job and a strong family history of heart disease.

And each had a heart attack without realizing she was having one.

"The day I think I had my heart attack, I stayed home from work because I wasn't feeling well," says Jefferson, an attorney. "I thought it was the remnant of a cold." Later that day, she says, she broke out in a cold sweat and was so weak she could barely walk from her shower to her bed. An emergency room doctor told her she probably had pneumonia. Weeks later, Jefferson was in the office of a cardiologist hearing that she actually had had a "massive heart attack."

Rickman, a preschool instructional assistant, does not know exactly when she had her heart attack. She remembers struggling to breathe for weeks around Christmas 2010 — but thought it was her asthma acting up. An emergency room doctor ordered heart tests, which led to a urgent stenting procedure that no doubt helped save her life, she says.

Jefferson and Rickman were among more than 260,000 women in the USA who have heart attacks each year, according to the American Heart Association. The association recently published its first official scientific statement on women's heart attacks, detailing the ways in which they sometimes differ from men's — including the fact that women are less likely to have obvious chest-crushing pain or to be diagnosed and treated quickly. They also are more likely to die: 26% lose their lives within a year of a first heart attack, compared with 19% of men.

"Heart disease deaths have been on the decline nationwide, but women still die from heart disease in greater numbers than men do," says report co-author Laxmi Mehta, a cardiologist and associate professor of medicine at The Ohio State University. Though not all the reasons are understood, the differences in how heart attacks develop, produce symptoms and are treated in women clearly contribute, she says.

Among the differences, according to the report:

Age. The average age for a women to have a first heart attack is 72, compared with 65 for a man. But when young women do have heart attacks, they are at particularly high risk for death compared with young men.

Causes. Though all heart attacks involve decreased blood flow to the heart, blockages often appear less severe in women — potentially giving which could give women and their doctors a false sense of security.

Symptoms. While Chest pain or discomfort is the most common symptom for both men and women, but women are more likely to have atypical symptoms such as shortness of breath, nausea and vomiting.

Treatment. Women are less likely to get appropriate medications after their heart attacks. And they are less likely to be referred to or attend cardiac rehabilitation — an exercise and counseling program that has been shown to increase survival and reduce post-attack depression.

"Only 20% of eligible women end up participating in rehab," says report co-author Theresa Beckie, a professor of nursing and cardiology at the University of South Florida. Lack of insurance or high co-pays can be a barrier, she says — but so can the need to show up three days a week for three months or so.

The time commitment "poses a lot of barriers, not just for women, but particularly for women, who might have children at home, who might be caring for a sick husband, who might be caring for elderly parents," Beckie says.

Jefferson and Rickman both say they were referred to rehab and attended (though Jefferson says she decided after a couple of weeks to return to her home exercise program, with her cardiologist's permission).

Rickman says it was tough, at first, to walk into a workout room full of much older people. "Every one of them asked, 'What are you doing here?" When she said she had had a heart attack, one man told Rickman he had had one at age 40 — and he was 80 years old. "It was my first sign that I would be able to watch my son grow up," Rickman says.

Despite the many grim statistics, there's good reason for women at high risk for heart attacks to feel optimistic, says Jennifer Mieres, a professor of cardiology at Hofstra Northwell School of Medicine.

"The encouraging piece is that if you know your risk, 80% could be prevented," she says. "We could prevent that first heart attack in many cases or prevent that second heart attack."

Among the keys to prevention, according the heart association says:

• Talk to your doctor about your risks, including your family history.

• Follow a heart-healthy diet, low in saturated fat, sodium and sugar and high in fruits, vegetables, whole grains, poultry, fish and nuts.

• Engage in at least 150 minutes a week of moderate physical activity. Add strength training a least a couple of times a week.

• Avoid smoking or being around tobacco smoke.

• Take medications to lower cholesterol and blood pressure, if your doctor says they are needed.

You can learn more at the association's Go Red for Women site (goredforwomen.org).


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