Rates spiked in recent years; risk factors hurt women more than men 02/07/2019
The classic image of a heart attack victim is an older man.
Yet, that image has never reflected reality, because women are also very vulnerable.
Men have a greater risk of heart attack than women do and suffer attacks earlier in life — but heart disease kills more women than breast or other forms of cancer do.
On average, men suffer a first heart attack at age 65, while women’s average age at a first heart attack is 72.
The rate of heart attack among women may be higher than realized, because more women suffer so-called “silent” — symptom-free or unrecognized — heart attacks.
Specifically, some 75 percent of female heart attacks are silent vs. 58 percent of male heart attacks — which may be because women tend to have higher pain thresholds (Øhrn AM et al. 2016).
Unfortunately, compared with men, women who suffer a heart attack tend to experience worse long-term outcomes — and that’s especially true of women aged 55 or younger.
These are the post-heart-attack challenges that women face more than men:
- Chest pain
- Loss of strength
- Lower quality of life
- Weaker mental performance
And a woman’s risk of dying during the first year following a heart attack is more than 50% higher than the risk for a male heart attack victim.
Two new studies reveal a sharp rise in the rate of in heart attacks among people — especially women — in their mid-30s to mid-50
Meanwhile, other recent research revealed that some key risk factors for heart attack affect women more deeply than men.
New research sees rise in heart attack risk among younger women
Researchers from the University of North Carolina and Boston’s Harvard-affiliated Brigham and Women’s Hospital presented some disturbing findings at the American Heart Association’s November 2018 science meeting in Chicago.
In short, they found that heart attacks are happening more often in younger people — especially in younger women (Arora S et al. 2018).
While heart attack rates in the United States have been declining among adults ages 35-74, the Carolina-Boston team found rising heart attack rates among adults ages 35-65.
They came to that conclusion after analyzing data from a multi-state study involving 28,732 people who’d been hospitalized for heart attacks between 1995 and 2014.
About 30% of those patients fell into the 35-54 age bracket, and the data analysis revealed that the proportion of younger heart-attack victims rose from 27% to 32%.
Women experienced a sharper rise in heart attack rates — from 21% to 31% — compared with men aged 35-65.
Making matters worse, women were less likely to receive preventive care, which would typically include cholesterol-lowering and antiplatelet drugs, beta blockers, coronary angiography, and coronary revascularization.
That list of interventions from the study’s authors was marred by a glaring omission: the need to raise people's typically low blood levels of “long-chain” omega-3s (DHA and EPA) — because low omega-3 levels rival high cholesterol levels as a predictor of heart risk.
That fact makes it critical for both genders to eat plenty of seafood and/or take omega-3 (fish or krill oil) supplements. Unfortunately, as we reported earlier this week, Americans are falling short on that score: see Americans Failing to Reach Ideal Omega-3 Levels.
The new study also revealed that rates of high blood pressure and diabetes were rising among all people who’d suffered a heart attack.
However, compared with men, women were more likely to have high blood pressure, diabetes, or chronic kidney disease.
Here’s how lead author Dr. Sameer Arora characterized their study’s implications: “Cardiac disease is sometimes considered an old man’s disease, but the trajectory of heart attacks among young people is going the wrong way. It’s actually going up for young women. This is concerning. It tells us we need to focus more attention on this population.”
Dr. Arora went on to make an important point: “Traditionally, coronary artery disease is seen as a man’s disease, so women who come to the emergency department with chest pain might not be seen as high-risk. Also, the presentation of heart attack is different in men and women. Women are more likely to present with atypical symptoms compared to men, and their heart attack is more likely to be missed.”
We outline the warning signs and symptoms experienced by women before and during a heart attack in “Know the symptoms”, below.
Woman affected more deeply by heart attack risk factors
The results of a second study — also published in November of 2018 — suggest that some of the key risk factors for heart disease exert greater negative effects on women than they do on men.
That research comes from The George Institute for Global Health at Britain’s University of Oxford (Millett ERC et al. 2018).
The authors analyzed data collected from 471,998 adults (ages 40-69) — just over half of whom were women — with no history of cardiovascular disease, who were followed for about seven years.
The Oxford team examined the effects of four heart attack risk factors — smoking, high blood pressure, obesity and diabetes — to measure the likelihood that each factor would lead to a heart attack.
When they measured the impact of each of those four risk factors, they concluded that each risk factor affected women more deeply than it did men:
- Smoking raised women’s risk by an extra 55%.
- High blood pressure raised women’s risk by an extra 83%.
- Type II diabetes raised women’s risk by an extra 47%.
- Type I diabetes raised women’s risk about three times more than men’s risk.
Here's how lead author Dr. Elizabeth Millett of The George Institute UK summarized their findings: “Overall, more men experience heart attacks than women. However, several major risk factors increase the risk in women more than they increase the risk in men, so women with these factors experience a relative disadvantage.”
Know the symptoms
Most women (95%) who experience a heart attack had noticed changes in their health status about one month earlier.
Sadly, the symptoms that women suffer when they’re experiencing a heart attack are often mistaken — by themselves or by medical professionals — for symptoms of stress, intestinal disorders, or panic attacks.
Chest pain is the most common heart attack symptom among men and women alike, but it’s less common among women, who may experience it as a sharp or burning sensation, rather than as the painful pressure reported by most women and men.
Compared with men, women experience other symptoms more commonly — and ignorance of that difference among medical professionals leads to routine misdiagnosis as well as delays in treatment.
So, it’s essential that women educate themselves on the heart attack warning signs and symptoms specific to, or more common among, females.
According to the American Heart Association and the Centers for Disease Control, these are the top symptoms that women experience, listed in approximate descending order of frequency:
One month before an attack
- Unusual fatigue
- Sleep disturbance
- Shortness of breath
- Racing heart
During a heart attack
- Chest pain (sometimes felt as “sharp” or “burning” pain)
- Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
- Shortness of breath
- Weakness or unusual fatigue
- Cold sweat, dizziness, and/or nausea
- Weak or heavy arms
- American Heart Association. Heart Attack Risk Factors: Women vs. Men – Go Red For Women.” Go Red For Women®., 16 Sept. 2013. Web. 12 Mar. 2017.
- Arora S, Stouffer GAR, Kucharska-Newton A, Qamar A, Vaduganathan M, Pandey A, Porterfield DS, Blankstein R, Rosamond WD, Bhatt D, Caughey MC. Twenty Year Trends and Sex Differences in Young Adults Hospitalized with Acute Myocardial Infarction: The ARIC Community Surveillance Study. Circulation. 2018 Nov 11. doi: 10.1161/CIRCULATIONAHA.118.037137. [Epub ahead of print] PubMed PMID: 30586725.
- Millett ERC, Peters SAE, Woodward M. Sex differences in risk factors for myocardial infarction: cohort study of UK Biobank participants. BMJ. 2018 Nov 7;363:k4247. doi: 10.1136/bmj.k4247. PubMed PMID: 30404896.
- Øhrn AM, Nielsen CS, Schirmer H, Stubhaug A, Wilsgaard T, Lindekleiv H. Pain Tolerance in Persons With Recognized and Unrecognized Myocardial Infarction: A Population-Based, Cross-Sectional Study. J Am Heart Assoc. 2016 Dec 21;5(12). pii: e003846. doi: 10.1161/JAHA.116.003846