When we think of heart attacks, we picture a middle-aged man clutching his chest as he collapses to the floor. Yet the reality is that cardiovascular disease and myocardial infarctions are the leading cause of death in women in America. Despite that reality, there has been a decades-long effort to educate health care providers to the fact that disease risk, symptoms, and treatment are different for women than for men.
This has culminated in a new and lengthy “Scientific Statement” from the American Heart Association entitled “Acute Myocardial Infarction in Women,” originally published in January, 2016. It is intended to be a scientific “wake-up call” for those who diagnose and treat women with cardiovascular disease, and a detailed description of the gender-based variations in presentation, diagnosis, and treatment.
The statement emphasizes that “sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction.” The conclusion of the statement states that cardiovascular disease “is an equal-opportunity killer, and since 1984 the mortality burden has been higher in women than men.” These differences are often compounded in women of color. The differences in clinical presentation had caused delays in diagnosis and treatment of women with such disease. The conclusion also points out that compliance by women is often suboptimal, which highlights the need for ”continued public health messages and interventions to target racial and ethnic minority women.”
In the section of the Statement regarding clinical presentation, it is pointed out that, although most patients present with typical chest pain or discomfort, women often present with atypical chest pain and symptoms such as dyspnea, weakness, fatigue, and indigestion. As result, “the detrimental consequences for women are misdiagnosis, delayed revascularization, and higher [heart attack] mortality rates.”
A number of studies have also found that women present later to treatment than men (53.7 hours for women and 16.6 hours for men). This delay is often due to “lack of awareness of risk, passivity, inaccurate symptom attribution, and barriers to self care.” These problems are more pronounced in older women, lower-income women, and in African –Americans and Hispanic women. The statement ends with a call for better education of both the public and of health care providers in order to eventually end the myocardial mortality gap between women and men.
