Finally. An official scientific statement on heart attacks in women.

31 Jan

“Sucks to be female. Better luck next life!”

You’re unlikely to spot this succinct summary within the pages of the new official scientific statement on women’s heart attacks from the American Heart Association, but that’s basically the message.(1)  That pithy summary, by the way, was originally quoted here from Laura Haywood-Cory, who at age 40 survived a heart attack caused by Spontaneous Coronary Artery Dissection.  (See also: Cardiac Gender Bias: We Need Less TALK and More WALK.
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The AHA statement, published this week in the journal Circulation to a flutter of media interest, basically confirms what I’ve been writing and speaking about for the past eight years: 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.   So my question this week (as a woman who was sent home from the ER in mid-heart attack with a misdiagnosis of acid reflux) is this:  if Laura and I and countless other women who’ve survived a heart attack have long ago reported on this “news”, why has it taken 92 years for the American Heart Association to produce its first ever scientific statement on myocardial infarction in female patients?  But don’t get me wrong – I’m always relieved to see any attempt from any major heart organization that helps to spread the word, so I’m running the full AHA news release for you here:  

 

A woman’s heart attack causes, symptoms may differ from a man’s

American Heart Association Scientific Statement

Embargoed until 3 p.m. CT / 4 p.m. ET Monday, January 25, 2016

Statement Highlights

  • Women frequently have different underlying causes of heart attacks than men, such as the types of plaque buildup.
  • Compared to men, women tend to be undertreated, and are less likely to participate in cardiac rehab after a heart attack. 
  • Risk factors such as high blood pressure and diabetes increase heart attack risk in women more severely than in men.

 

DALLAS, Texas, Monday, January 25, 2016 —A woman’s heart attack may have different underlying causes, symptoms and outcomes compared to men, and differences in risk factors and outcomes are further pronounced in black and Hispanic women, according to a scientific statement published in the American Heart Association’s journal Circulation.

The statement is the first scientific statement from the American Heart Association on heart attacks in women. It notes that there have been dramatic declines in cardiovascular deaths among women due to improved treatment and prevention of heart disease as well as increased public awareness.

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 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.

Causes:

Heart attacks caused by blockages in the main arteries leading to the heart can occur in both men and women. However, the way the blockages form a blood clot may differ.  Compared to men, women can have less severe blockages  that do not require any stents;  yet the heart’s coronary artery blood vessels are damaged which results in decreased blood flow to the heart muscle.  The result is the same – when blood flow to the heart is decreased for any reason, a heart attack can occur. If doctors don’t correctly diagnose the underlying cause of a woman’ heart attack, they may not be prescribing the right type of treatments after the heart attack.  Medical therapies are similar regardless of the cause of the heart attack or the severity of the blockages. However, women are undertreated compared to men despite proven benefits of these medications.  (Note from Carolyn:  SCAD survivors like Laura Haywood-Cory will be pleased to see that this AHA statement also includes half a page on heart attacks caused by Spontaneous Coronary Artery Dissection).

Treatment:

Women face greater complications from attempts to restore blood flow because their blood vessels tend to be smaller, they are older and have increased rates of risk factors, such as diabetes and high blood pressure. Guideline-recommended medications are consistently underutilized in women, leading to worse outcomes.  Also, cardiac rehabilitation is prescribed less frequently for women and even when it is prescribed, women are less likely to participate in it or complete it.

Symptoms:

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.

Risk factors:

Risk factors for heart attacks also differ in degree of risk in men compared to women. For example, high blood pressure is more strongly associated with heart attacks in women and if a young woman has diabetes her risk for heart disease is 4 to 5 times higher compared to young men. 

Racial differences:

Compared to white women, black women have a higher incidence  of heart attacks in all age categories and young black women have higher in-hospital death rates.  Black and Hispanic women tend to have more heart-related risk factors such as diabetes, obesity and high blood pressure at the time of their heart attack compared to non-Hispanic white women.   Compared to white women, black women are also less likely to be referred for important treatments such as cardiac catheterization..

Understanding gender differences can help improve prevention and treatment 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.

Statement co-authors are Theresa Beckie, Ph.D.; Holli DeVon, Ph.D., R.N.; Cindy Grines, M.D.; Harlan Krumholz, M.D., S.M.; Michelle Johnson, M.D., M.P.H.; Kathryn Lindley, M.D.; Viola Vaccarino, M.D., Ph.D.; Tracy Wang, M.D., M.H.S., M.Sc.; Karol Watson, M.D., Ph.D.; Nanette Wenger, M.D.
Author disclosures are on the manuscript.

  

(1) Laxmi S. Mehta et al. Acute Myocardial Infarction in Women. A Scientific Statement From the American Heart Association.  

Screen Shot 2016-03-25 at 5.06.28 PM

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Q:  Did anything surprise you in the AHA statement?

Meanwhile, A Few Things I’ve Been Writing About While Waiting Around for this AHA Statement:

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17 Responses to “Finally. An official scientific statement on heart attacks in women.”

  1. Sarah Jones September 30, 2016 at 12:27 am #

    Thank you for all this information. I found your site last night when I woke up sweating, anxious and experiencing chest pain. The survivor stories here were detailed enough that I felt confident that I was experiencing indigestion rather than a heart attack. And having now read lots of your articles I am now much better informed of what to look for if something does go wrong.

    The reason I am commenting specifically on this one is because of the additional impact of race that you identify at the end. I would love to see some other articles address this issue specifically. I have been reading a lot about intersectional feminism recently and whenever I see this now it really strikes me. There is something very hurtful in acknowledging but not addressing the compounding effect of gender and racial bias. It is like an aside of “yes it sucks to be black and female even worse than it sucks to be white and female, but whatever, now back to me….”

    I mention this not as an attack but as a plea for greater awareness and in the hope that we as the human population of the world will start to collectively address racial bias as well as gender bias, instead of all simply ignoring the one(s) that don’t affect us personally. And with gratitude and respect for all the work that you do.

    Like

    • Carolyn Thomas September 30, 2016 at 5:23 am #

      Thanks for sharing that perspective, Sarah. Your comment reminds me of another observation from a longtime reader who had noticed that virtually all of the images of women that I’d been selecting to accompany my posts are of white women. And she was right! Since then, I do try to balance those selections with a more diverse range of photos. Similarly, I often get complaints from readers who ask why I spend so much time writing about heart attack instead of _____ (fill in the blank with their particular cardiac diagnosis). So I did begin to deliberately include topics like congenital heart disease or heart failure, just to make sure readers with those diagnoses were happy, too. And whenever I write about yet another study on women’s specific experience with heart disease, men contact me demanding to know why I’m ignoring the male experience.

      But here’s my point: this is my personal one-woman blog, not an academic resource, and like all bloggers, I get to write about what I’m most interested in. I write about heart attacks because that’s what I had. If I were a Filipina woman blogging about lupus, you can bet I’d be focusing only on those uniquely specific characteristics, and likely readers would still be wanting to know when I’m going to start covering Jamaicans with rheumatoid arthritis instead.

      In this particular post, the AHA report does specifically identify racial differences (this post in fact contains three entire paragraphs on that difference), so it hardly seems that I’m saying “whatever, back to me…” as you are implying. Thanks for the reminder to watch out for that.

      Liked by 1 person

      • Sarah Jones September 30, 2016 at 8:09 am #

        Thank you for responding. I think my impression was formed when I scanned the titles of all the other articles listed below this one and didn’t see anything addressing the compounding effect of racial bias. I appreciate that this is your personal blog. I raised the question because it seems like you are influential in this field and that racial bias is a topic worthy of consideration in this context.

        I have engaged in and followed discussions along these lines between women from different perspectives. The thing that always strikes me is that white women’s reasons for ignoring black women’s experience are identical to men’s reasons for ignoring women’s experience. (Too hard, too complicated, nothing to do with me, I don’t want to engage with this, too uncomfortable, too distracting, I’m a good person and this criticism feels unfair.)

        I’m still on this journey myself and have struggled with it as a white woman involved in feminist movements in the UK. But I do think it’s important and that’s why I wanted to flag it to you. Best wishes.

        Like

  2. Curious to the Max February 5, 2016 at 12:39 pm #

    I’m guessing that one of the reasons it’s taken almost a century to figure men and women have different symptoms and needs is that the medical establishment – physicians, researchers, CEO’s etc – has been pretty much dominated by men. Thank goodness that’s changing – just not fast enough for my lifetime!

    (An interesting brain research aside, but connected to my comment – our brain looks for familiar patterns to make sense of our world – so male brains recognize what is familiar and discard or put unfamiliar sensory cues in the background).

    Liked by 1 person

    • Carolyn Thomas February 5, 2016 at 1:58 pm #

      Thanks so much Judy-Judith for that thought-provoking observation.

      That associated brain research is fascinating, and makes perfect sense, doesn’t it? I wrote about something similar one day when I was trying to make sense of misdiagnosis rates (see “Seven Ways to Misdiagnose a Heart Attack” – one of which is called Confirmation Bias – e.g. “looking for evidence to support a pre-conceived opinion, rather than looking for information to prove oneself wrong.“)

      Like

  3. Joan Jahnke February 3, 2016 at 8:48 am #

    Sure needs better plans on education to practicing physicians which can run from Family Practice, internists, vascular, GI, pulmonary and cardiologists and pysch. The ER may see plenty of chest pain, but they should not be first line diagnosis when the EKG and blood enzymes are ‘negative’…..that could be a fatal flaw releasing a patient to home with a follow up with personal doctor that may take weeks or make a patient think “Well, the ER said it was all ok”.

    Where are the “Guideline-recommended medications?” as referenced in this statement? The most important information here, and my 8 year mission statement for my Coronary Microvascular Disease, is directly from this statement: “…yet the heart’s artery blood vessels are damaged which results in decreased blood flow to the heart muscle. The result is the same – when blood flow is decreased for any reason, a heart attack can occur.”

    Any heart attack, lack of oxygen to any area of heart muscle from micros to larger vessels can be a spotty, small or large damage result with angina/ischemia.

    Eliminate immediate threat in the patient first, preferably with a stat cath, then proceed to treatment. I look forward to a blending of practice specialty areas of medicine in a quick team approach to any heart symptoms. My first local cath was quick in 2005. Now if a symptomatic patient enters Emory Cardiology, it is now a stat cath, then treatment plan based on even inconclusive findings like no large coronary narrowing or obstructive disease. Doctors: first believe the patient.

    On Jan 31, 2016 7:10 AM, “Heart Sisters” wrote:

    “Sucks to be female. Better luck next life!” You’re unlikely to spot this succinct summary within the pages of the new official scientific statement on women’s heart attacks from the American Heart Association…

    Liked by 1 person

    • Carolyn Thomas February 3, 2016 at 2:24 pm #

      So many good points, Joan! Yet I’m guessing that when ER docs see EKG and blood enzymes test results that are ‘negative’, the chances of those patients being misdiagnosed and sent home with instructions to ‘go see your GP’ are excellent. Lots of research confirms this “bias” (here and here, for example). ER docs are the de facto gatekeepers that can keep heart patients from accessing cardiology department services.

      Your “First Believe The Patient” advice would be awesome if only it were embraced by ALL frontline gatekeepers…

      Like

  4. Chris Khayat February 1, 2016 at 6:05 am #

    I am curious – when the article says women are “undertreated” compared to men, what do they mean? Less drugs? Fewer bypasses and stents?

    Liked by 1 person

    • Carolyn Thomas February 1, 2016 at 6:38 am #

      Yes, yes, and yes to all, Chris. Check some of the links listed at the end of this post for some pretty alarming examples of this ongoing undertreatment in women. Previous studies, for instance, have confirmed these specific differences between male and female heart attack patients:

      – men were 72% more likely to receive clot-busting drugs than women
      – men were 57% more likely to receive a diagnostic angiogram
      – men were 24% more likely to have balloon angioplasty to reopen a blocked artery once identified by angiography
      – the death rate among men was 48% lower than that for women during their hospital stay

      It’s pretty discouraging – and frightening.

      Like

  5. Stacey Buchholtz February 1, 2016 at 5:56 am #

    I am a volunteer for the AHA working with the goal to bring awareness to women. I am the passion speaker at the Orange County Go Red For Women Lunch and I see the AHA as an incredible forum to bring awareness to women and feel they are doing so much towards this cause. I have done local radio spots and have seen hundreds of other women doing the same across the country.

    Thanks for your work to bring awareness. I think we should be a little more appreciative to the AHA for their positive contributions.

    Liked by 2 people

    • Carolyn Thomas February 1, 2016 at 6:26 am #

      Thanks Stacey for all you do to help promote heart health awareness in women! We need a small army of dedicated volunteers just like you to help increase awareness of our #1 killer. The AHA has indeed helped to raise that awareness (the brilliant “Just A Little Heart Attack” video by Elizabeth Banks, for example, might well be the most effective 3-minute patient education campaign ever!)

      But raising awareness among women and issuing an official scientific statement aimed at health care providers are two different issues. It’s taken generations to produce this official AHA statement, and that delay is hard to justify, especially coming from a national organization that purports to be a leader in the field. Red dress fashion shows don’t improve existing diagnostic/treatment decisions made by frontline healthcare professionals, the ones who are actually doing the “underdiagnosing and undertreating” of women who come to them for help during a cardiac event. These are also the ones who read/rely on evidence-based science as itemized in this first-ever and long overdue scientific statement.

      Like

      • Taryn February 1, 2016 at 8:56 pm #

        Carolyn and Stacey — I want to thank you both for all the work you are doing to let people know about women’s heart disease.

        Last July at the age of 51, I spent 3 weeks of going to various primary care appts before I was finally diagnosed with having had a heart attack — a heart attack that could have been prevented if I had been referred for evaluation when I first presented with clenching chest pain.

        I continued to have problems and was basically told that my “big brain” was the cause of my continued symptoms. I was able to change insurance companies and within 7 days in the new insurance was diagnosed with another 90%+ blockage that required a stent. I saw women providers for most of these visits, so it is clear to me that just having someone of the same gender is not enough to have consciousness about these issues.

        I applaud both of you for your advocacy. As I begin to feel stronger, I am hoping to also do more educating in my community.

        Liked by 1 person

        • Carolyn Thomas February 2, 2016 at 6:20 am #

          Thanks for sharing your unique perspective, Taryn. That’s the first time I’ve heard “big brain” blamed for cardiac symptoms! You’re correct: the gender of one’s cardiologist is no guarantee. My own specialists happen to be males and are very well-informed on all aspects of women’s heart disease. Speaking of which, just today the journal Mayo Clinic Proceedings published a paper explaining why hospitals need specific Women’s Heart Clinics because of the “profound knowledge gap in the awareness, prevention, diagnosis, and treatment of heart disease in women” among health care providers. A brilliant move in the right direction! While you’re recuperating, check out the WomenHeart Science & Leadership Symposium for Women With Heart Disease at Mayo Clinic – you might consider applying some day.

          Like

Trackbacks/Pingbacks

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