“Women’s Heart Attack Myth”? Revisiting the controversial Canadian study

28 Nov

heart man woman cards

by Carolyn Thomas      @HeartSisters

Media coverage of a study presented at the annual Canadian Cardiovascular Congress last month has left me and other Heart Sisters gobsmacked.  One heart attack survivor told me:

“This ‘research’ has set back women’s awareness of heart attack symptoms by a full decade!”

What could have inspired a reaction like this?  First, there are the media headlines, “The Heart Attack Myth”.  

Second, there’s the research methodology (the way this study was designed). And finally there’s the reporting of the study’s conclusion:  essentially, that there are no differences at all in heart attack symptoms between men and women.

This study looked at 305 patients undergoing routine, scheduled, non-emergency angioplasty procedures in hospital. (Watch this 30-second video describing an angioplasty procedure).  Based on cardiac symptoms that patients reported during the momentary full blockage while the angioplasty balloon expands inside the coronary artery (ostensibly imitating what happens during an actual heart attack), the study’s author jumps to the conclusion that women always experience the same chest pain symptoms that men do during a real life heart attack.

Oddly enough, media coverage rarely touched on another of the study’s key findings: that women heart attack survivors in this study suffered “significantly more throat, neck and jaw pain” than men. Tragically, this omission is a missed educational opportunity. Where were the big headlines for this important news?

Scratch any heart attack survivor and you’ll likely uncover an amazing litany of weird symptoms – some so weird you’d never believe them to be remotely cardiac in nature.  Lips turning numb, persistent coughing, elbow pain, earache, heavy sensation in the hands, vomiting, fever – do these sound like heart attack warning signs to you?  Yet these and many other relatively unfamiliar symptoms are reported by women every day during real-life heart attacks. These unusual symptoms are important to know because 8-10% of women report no chest symptoms at all during a heart attack.(1) (Results of many studies on this absence of chest pain in women vary, by the way, from 8-42%).

Since I started doing public presentations about women and heart disease, it’s been an uphill battle to convince women of the need to recognize and respond immediately to heart attack symptoms – ALL symptoms. These may include the textbook sign of chest pain (as I experienced myself during my own heart attack) but also include many vague symptoms that women report. I have yet to meet any woman who is unaware that chest pain is linked with heart attack, but many are very surprised to learn about less common symptoms.  If only media coverage of this study had featured women’s commonly experienced throat, neck, and jaw pain symptoms as the major headline, instead of the catchy but misleading “Heart Attack Myth”.

So I felt confused and dismayed by this study’s growing media pickup, as we say in public relations, as well as the buzz in cardiac circles among survivors, particularly about the media emphasis on chest pain.  Staff at both Medpedia and our local Heart and Stroke Foundation office e-mailed me when the study hit the news to ask if I’d seen it yet.

I knew I had to go to an expert to answer growing concerns about what had become high-profile news.  For me, that meant only one person: Mayo Clinic cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic in Rochester, Minnesota. I contacted Dr. Sharonne and asked for her own take on the ‘Heart Attack Myth’ news coverage.  Here’s how she responded:

“Their study is not conclusive – that would be a bit of a stretch – but everything else that is quoted is factual and/or good advice, except for the last sentence in the second paragraph of the news release. (‘Both the media and some patient educational materials frequently suggest that women experience symptoms of a heart attack very differently from men,’ says cardiac nurse Martha Mackay, a Canadian Institutes of Health Research clinical research fellow and doctoral student at the UBC School of Nursing. These findings suggest that this is simply not the case.’)

“Every patient has unique symptoms. While there may be a few more women with nausea and vomiting, and a few more men with obvious chest symptoms or radiation down the left arm, both may have a 25-30% ‘atypical’ presentation rate.  So it is not accurate to state definitively that women have more ‘atypical’ symptoms. Women do have MORE symptoms, however, making it more challenging to sift through all of them and come up with a diagnosis.

“The other issue is that the only way we are going to get the answer to this is more research, and if we ask for more research, we cannot just reject as flawed any study that does not fit with what we believe. Instead, we have to put that research into perspective.

“No study, including this one, is the be-all/end-all. Each piece of research builds on the prior studies, and this one is valid to the point that it demonstrates that men and women experience similar symptoms when they have ischemia due to an acutely occluded coronary artery (which is what happens during a heart attack in many, but not all people). What it does not translate to is that there are no sex differences in heart attack symptoms. Not every heart attack occurs as a result of sudden, complete blockage such as this. And we do not have prospective sex-based data on symptoms.”

Dr. Sharonne Hayes also included in her e-mail to me something she had written two years ago for WomenHeart: The National Coalition for Women With Heart Disease:

“Even when women have ‘classic’ heart attack symptoms, they are more likely to be misdiagnosed and have delayed care compared to men. This has nothing to do with sex differences, but does have to do with the need for better health care provider education and diagnostic tools.

“Women need early detection (which means early recognition of symptoms), accurate diagnosis (symptoms taken seriously and investigated appropriately) and proper treatment.”

Find out more about heart attack signs that both men and women can experience. And no matter what symptoms you may experience, pay attention to that little voice that warns you ‘Something is wrong with me!’

You know your body. You know when something is not right. Don’t ignore that little voice, for it could save your life.

(1) S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026.

UPDATE, JANUARY 31, 2016:   The American Heart Association releases its first ever scientific statement on women’s heart attacks, concluding (as I’ve been writing here since 2009) that “while the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.”  The summary of the statement: if you’re a woman having a heart attack, you’re more likely to be underdiagnosed – and then undertreated even when appropriately diagnosed – compared to our male counterparts.  

See also:

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15 Responses to ““Women’s Heart Attack Myth”? Revisiting the controversial Canadian study”

  1. HA in Malibu November 5, 2011 at 5:47 am #

    I just found this article today as a link from your new post this week.

    Your own distressed reaction at the time was EXACTLY how I felt too when I first read about this study a couple years ago (who could miss it? these ‘heart attack myth’ headlines were EVERYWHERE). WTF?!?

    Like

  2. Romana G.F. October 7, 2011 at 3:59 pm #

    The media headline should NOT conclude anything at all about women’s symptoms during a HEART ATTACK being different from men’s symptoms, but only that women’s symptoms during that one small moment during a CARDIAC CATHETERIZATION procedure when the angio balloon is fully expanded inside the coronary artery. As Dr. Hays says here, not all heart attacks involve a fully blocked artery so the researcher’s conclusion is essentially meaningless.

    Like

  3. canadian December 22, 2009 at 11:41 am #

    This DOES seem controversial to me, too, because on one hand we have all this information out there telling us, for example, that a large number 40% of women having a heart attack do NOT experience chest pain, yet we have this study now saying that men and women experience chest pain as THE heart attack sign. Confusing and certainly not conclusive, as the mayo clinic doc correctly reminds us. Thanks for helping to clarify this issue.

    Like

  4. Ambulance Chick December 19, 2009 at 4:27 pm #

    I really don’t see the ‘controversy’ here. It seems simple: if some women have zero chest symptoms during a heart attack, then we all need to know what it might feel like when a heart attack hits. You have a must-read essay on this site (How Does It Feel To Have A Heart Attack?) that all women should be forwarding to their doctors, and all Emerg.Room doctors should memorize. Doctors should stop focusing on cardiac CHEST PAIN and let’s help inform women about ALL potential danger signs, all of them, and your most important message: listen to that little voice inside that tells you when something is not right and then get help immediately.

    Like

  5. Dr. Jill December 18, 2009 at 5:43 pm #

    Well, I’m glad to finally find an intelligent reaction to this study and the questionable interpretation of its ‘results’. The original media coverage even included cardiology and academic newsletters that just continued to pass on the original ‘myth’ press release, thus muddying the waters and confusing the already-confused. I’ve been trying unsuccessfully to ‘undo the damage’ by posting more balanced coverage of this and other confusing research in our practice public areas. I will add a copy of this essay to our patient board. Thank you.

    Like

  6. RN in NM December 18, 2009 at 5:55 am #

    The media coverage of this study has been VERY unfortunate, really tragic in my opinion. Such a missed opportunity to educate and inform; especially since the REAL news here – women experience “significantly higher” rates of throat neck jaw pain during a heart attack – is buried at the end of the story, or not even mentioned. This is criminal. The study authors should be issuing a media bulletin to correct this misinformation.

    Like

  7. Justin December 18, 2009 at 4:13 am #

    Media coverage of this study interests me. You can’t necessarily blame the researcher Ms McKay for this misleading headline about her “news”.

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  8. Anon. December 17, 2009 at 10:49 pm #

    Yes, it may be accurate that women do have some kind of chest symptom, but it’s hard enough as it is to get this group to seek immediate care, which is why we MUST continue to stress ALL potential Heart Attack symptoms and keep hammering this message home to women, which is regrettably what this study failed to do.

    Like

  9. Irene December 17, 2009 at 11:08 am #

    While it is true that a percentage of women may experience no chest pain during a HA, that still means many women DO have chest pain so it remains the most common cardiac symptom for both men AND women. This canadian study however misses the boat when it comes to educating all women about some of the other “signficant” symptoms more commonly seen in women like that throat and jaw and neck discomfort mentioned, and this just means that those of us who work in women’s health have more work to do in raising awareness. It’s hard enough as it is to convince women that heart disease isn’t just for men.

    Like

  10. Lab Rat December 13, 2009 at 6:49 am #

    I agree with your assessment. So much of “research” is wide open to subtle or profound bias, methodology flaws, tainted assumptions. Sometimes a published trials abstract will even quote the lead author as saying, “We were disappointed in these results…” which flat out tells you about his bias even going in. I suspect in this angioplasty ‘study’, however, that the study author’s motives may have been pure science, but the media picked up the unfortunate ‘heart attack myth’ headline and ran amok with it. Pity…

    Like

  11. Marie-Claire December 10, 2009 at 9:41 am #

    I saw these news on Reuters and I too was also surprised by ‘headlines’. In Europe we have not heard this myth from docteurs so very surprising. Thanks you for this new information it makes sense to what we know already about heart attacks and the women: chest pain perhaps, but not all times.

    Like

  12. Womens Health Partners December 7, 2009 at 7:50 pm #

    Our staff and patients brought this to our attention in October, and we too were discouraged by the misleading black and white ‘heart attack myth’ headlines. Few if any women in our practice do not know what chest pain might mean, but our concern with this study, and worse, the accompanying flurry of “news” headlines covering it, is that women are no more educated than ever now about OTHER important warning signs that could also spell a cardiac event, such as the ‘NECK, THROAT, JAW’ symptoms that are significantly higher for women than for men during an M.I. In fact, women are likely more confused now than ever thanks to this “study” and its resulting publicity. As Dr. Hayes of Mayo sums it up: “not conclusive – more studies needed”.

    Thank you also for confirming the important and well-documented reality that many women experience no chest symptoms of any kind (this includes pain, tightness, heaviness, etc.). Our counsel to patients is that inexplicable or distressing symptoms of any kind should be considered cardiac in nature until proven otherwise.

    Our clinic is hosting an annual Women’s Health Education Day in the New Year and we would like your permission to reprint and incorporate your essays, along with the original study news release, as part of our teaching curriculum to point out how careful women as consumers must be when it comes to interpreting health news they read or hear in the media.

    Thank you for helping us and other clinicians in our efforts to convince women to PAY ATTENTION to their bodies’ early warning signals.

    L. Brown, MD

    Like

  13. NYC Cardiac Rehab December 1, 2009 at 8:31 pm #

    My staff and I were also dismayed by the clever ‘Heart Attack myth’ headlines but not really surprised by the wide ‘media pickup’ with a headline like that. I wasn’t sure if it was the study’s actual intent, or just a creative newspaper editor who came up with that misleading phrase because it attracts wider readership than the actual minimal findings would, which as Dr. Hayes correctly points out, are not conclusive. We consider it extremely unfortunate here that women’s “significant” neck, throat and jaw symptoms were not prominently featured in the headlines instead of the inaccurate word “myth”.

    We’ve had hundreds of women survivors coming through our hospital-based rehab program, after the fact, who tell us that they hadn’t known at all that their early jaw or neck symptoms were even remotely associated with a heart attack. Thank you for helping to educate all women about ALL potential MI symptoms – not just chest pain.

    Like

  14. Cheryl Relf November 30, 2009 at 8:43 am #

    Thank you once more Carolyn for keeping us informed! I read and listened to the ‘myth’ with surprise………….and am so glad that you have cleared this up for me. YOU are awesome and I love your website.

    Like

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  1. Women’s Health - January 5, 2010

    We have included a link to this article from our website story: Has Your Health Improved or Declined in the Past Decade? — Heart Attack Myth? Media coverage of a study presented at the annual Canadian Cardiovascular Congress last month has […]

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