Cardiovascular disease is the leading cause of mortality in American women. A new scientific statement published in the American Heart Association's journal Circulation
states that women's heart attacks may have different causes, symptoms and outcomes as compared to men.
The statement is the first of its kind from the American Heart Association on heart attacks in women. "Despite stunning improvements in cardiovascular deaths over the last decade, women still fare worse than men and heart disease in women remains underdiagnosed, and undertreated, especially among African-American women," said writing group chair Laxmi Mehta, M.D., a noninvasive cardiologist and Director of the Women's Cardiovascular Health Program at The Ohio State University.
While heart attacks are caused by blockages in the main arteries in both men and women, the way these blockages form a blood clot may differ in women. Women can have less severe blockages that do not require stents but at the same time, their coronary artery blood vessels may be damaged which could result in decreased blood flow to the heart muscle. It is important for doctors to correctly diagnose the underlying cause so that they prescribe the right type of treatments for female patients.
Women have smaller blood vessels therefore they can face greater complications. This is further aggravated if they have other risk factors such as diabetes and high blood pressure. Recommended medicines are still underutilised in women which is a primary cause of poor outcomes among female patients. In addition, women are less frequently prescribed cardiac rehabiilitation as compared to men and even if prescribed, women are less likely to participate or complete it.
The most common heart attack symptom is chest pain for both men and women but women are also more likely to demonstrate atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain. In addition, risk factors for women also differ in degree as compared to men. High blood pressure has been found to be strongly associated with heart attacks in women. Also, the risk of heart disease for a young woman with diabetes is 4 to 5 times higher as compared to a young man.
There are also racial differences that exist. Black women have a higher incidence of heart attacks as compared to white women. This is true across all age categories. Young black women also have higher in-hospital deaths. Similarly, black and Hispanic women have a higher prevalence of heart-related risk factors including diabetes, obesity and high blood pressure at the time of heart attack as compared to non-Hispanic white women. Black women are also less likely to be referred for proper treatment such as cardiac catheterisation.
The statement from AHA is thus making it abundantly clear that understanding these gender differences is imperative to ensure prevention and treatment of heart disease among women.
"Women should not be afraid to ask questions - we advise all women to have more open and candid discussions with their doctor about both medication and interventional treatments to prevent and treat a heart attack," Mehta said.
"Coronary heart disease afflicts 6.6 million American women annually and remains the leading threat to the lives of women. Helping women prevent and survive heart attacks through increased research and improving ethnic and racial disparities in prevention and treatment is a public health priority," she said.
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