Women under age 55 fare worse after heart attack than men

by Carolyn Thomas

There was more distressing news for women from researchers reporting at the 64th Annual Canadian Cardiovascular Congress in Vancouver. To the surprise of no one who’s been following women’s heart health lately, a Heart and Stroke Foundation study has found that women under age 55 fare worse than their male counterparts following a heart attack, and their health status declines more than that of their male counterparts. The AMI55 study* found that women heart attack survivors studied had:

significantly worse physical limitations
more recurrences of chest pain
worse quality of life than men
declined in both physical limitations and recurrences of chest pain compared to their baseline scores (but among men studied, only physical limitations worsened from baseline to one month).

Dr. Karin Humphries, the Heart and Stroke Foundation Professor in Women’s Cardiovascular Health at Vancouver’s University of British Columbia, explained:

“While the high prevalence of traditional cardiac risk factors like diabetes, smoking, and high blood pressure contribute, they do not fully explain the poorer outcome in women. This is why our study focuses on exploring non-traditional risk factors such as depression, anxiety, and social support.”

Dr. Humphries attributes the slower recovery of women in part to prevalent social and cultural standards that typically place women in this age group in the role of primary caregiver:

“These women are likely not getting the support they need to recover from a heart attack. They have jobs, children and, as members of the sandwich generation, may also be taking care of elderly parents at the same time.

“So typically, women go through this denial about their symptoms or about the rehabilitation they defer after the heart attack, and they have this guilt about all the things they have to take care of, except for their own health.

“Women are also less likely to attend cardiac rehabilitation than their male counterparts even when they are referred.”

When I met with Dr. Humphries and her co-researcher Mona Izadnegahdar (a PhD candidate in epidemiology at the UBC School of Population and Public Health) to discuss this study, I asked them what advice they might now give to help women overcome barriers to – at the very least – participating in cardiac rehab, for example, widely considered an essential part of recovery. Dr. Humphries issued this warning to women:

“In order to help your families, you have to take care of yourself!”

I also asked them if any results of their research surprised them. “Smoking!” they declared. Mona explained:

“In our study’s demographic (all of whom were heart attack survivors), almost 50% of our female participants were current or former smokers, and most of these were in the 45-55 age group.”

Familiar explanations for the overall difference in men’s and women’s outcomes may also be that:

women are presenting to hospital later
women are less likely to believe they’re having a heart attack
women are more likely to put off seeking treatment
women often ignore or under-report their symptoms
women are less aggressively investigated for heart disease

And Mona added:

“We can improve these odds by increasing women’s awareness of warning signs and symptoms of heart attack, and by recognizing and managing cardiac risk factors.”

One hopes that we might also improve these odds by engaging in future cardiac studies whose methodology includes a more representative gender balance. Small sample sizes of female participants reduce the power of any study, as suggested by An Introduction to Medical Statistics (Oxford University Press, 1995). In this case, for example, women made up only about one-quarter (75 women) of the total sample population of the 278 patients studied.

According to the Heart and Stroke Foundation’s spokesperson Dr. Beth Abramson:

“It’s important to put a gender lens on heart research. Women must be better represented in research.”

* M. Izadnegahdar, J. Singer, M. Gao, J. Kopec, KH Humphries. “Sex Differences in One Month Health Status of Young Adults Post Acute Myocardial Infarction: Preliminary results from AMI55 study”, Canadian Journal of Cardiology, Volume 27, Issue 5, Supplement, p. S152, September 2011.

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