By Dolores Kong, The Boston Globe
Young and middle-aged women who suffer a heart attack are twice
as likely to die of it as men of the same age, while women of all
ages are more likely to have complications and harder-to-diagnose
symptoms than men having a heart attack, according to two major new
studies.
The findings, based on data from nearly 400,000 hospital
patients, provide one of the most comprehensive looks at women and
heart disease, an issue that is turning out to be much more complex
than previously thought. And they suggest that some aspects of
heart disease are biologically different in women, which could have
ramifications for diagnosis and treatment.
Three or four decades ago, heart disease was popularly seen as
primarily affecting middle-aged men. More recent emphasis on heart
disease as the No. 1 killer in the United States of both women and
men has raised public awareness, but there is still the perception
that heart disease is not as much a problem for women, until
perhaps after they reach their 70s.
As these two new studies in the New England Journal of Medicine
indicate, ``We certainly can't afford to be complacent about
symptoms of heart disease in women, irrespective of their age,''
said Dr. JoAnn Manson, principal investigator for the federally
funded Women's Health Initiative at Brigham and Women's Hospital in
Boston, who has reviewed the studies and found they make important
contributions.
One of the studies, by researchers at Yale and elsewhere,
documented for the first time that women in the 30-49 age group who
have a heart attack are twice as likely to die during
hospitalization as men of the same age -- 6.1 percent for women vs.
2.9 percent for men.
In fact, the study found, women of almost all age groups who
suffered heart attacks died at a higher rate than men, with the
disparity gradually lessening with age. It was not until the 80-84
age range before women with heart attacks were less likely to die
from them -- 21.5 percent for women vs. 21.8 percent for men.
``The younger the woman is when she is having a heart attack,
the greater the risk of dying in the hospital,'' said Dr. Viola
Vaccarino, assistant professor of epidemiology at Yale University
School of Medicine and the lead author. ``Our study opens up the
question, what is it about younger women that puts them at higher
risk than men of similar age?''
The findings, based on an analysis of data for about 385,000
patients, looked at deaths occurring during hospitalization and may
not necessarily apply to deaths outside the hospital. But
nationwide, many, if not most, heart attack deaths occur during
hospitalization. The report also took into account possible bias in
how physicians treat women, but found that could only explain 10
percent of the disparity between death rates for women and men.
Dr. Patrice Nickens, director of the heart research program for
the National Heart, Lung and Blood Institute, called the finding
about younger women ``very important'' and ``provocative.'' While
most heart attacks in both women and men still occur after the age
of 50, Nickens said, ``We need to understand what's going on in
these (younger) women.''
Researchers have known that men, especially those younger than
65, are at higher risk of developing heart disease than women, but
women are more likely to die if they suffer a heart attack. They
have attributed the higher death rate among women to the fact that
women tend to be older before developing heart disease, when with
menopause they lose the protective effects of estrogen. This is the
first study to specifically show that younger, pre-menopausal women
who suffer heart attacks die at a higher rate than men of the same
age who suffer heart attacks.
The study's authors theorized that women at risk may be more
likely to experience spasms in blood vessels and have differences
in blood clotting mechanisms, among other disparities.
The second study in the current New England Journal, by
researchers from New York and elsewhere, looked at data from more
than 12,000 patients hospitalized with symptoms of a heart attack,
and found that women are more likely to have such complications as
major internal bleeding and heart failure, and to have such other
illnesses as diabetes.
And, interestingly, the study found that women with chest pains
did not show the kind of blood vessel blockage that men with chest
pains did. While more than 85 percent of the men with ``unstable
angina'' had significant blockage, only about 70 percent of the
women did, according to the study.
``First of all, the message is for researchers to try to
understand the differences so that we can better target the therapy
for both women and men,'' said Dr. Judith S. Hochman, director of
the cardiac care unit at St. Luke's-Roosevelt Hospital in New York,
and lead author of the second study.
And secondly, women should realize they may be at risk for heart
disease, and take steps to prevent it, said Hochman, who is also
chairwoman of the Women's Health Initiative advisory committee to
the National Heart, Lung and Blood Institute.
``The role of heart disease in women has not gotten the
attention that it should get,'' agreed Dr. Deeb N. Salem, past
president of the New England affiliate of the American Heart
Association and chairman of medicine at New England Medical Center
and Tufts. ``What these two articles are going to do is to
stimulate more research in this area.''
Diana Savoie of Danvers, Mass. was 49 when she had a heart
attack four years ago, and knows she is lucky. She has diabetes and
a family history of heart disease, which places her at greater risk
of a heart attack.
``I didn't have typical chest pains, or the feeling that an
elephant was sitting on my chest. There was no numbness in my arms
or hands. I had a sharp pain that was behind my left breast and
went out to my back. It was nothing that made me think it would be
my heart.''
But Savoie knew something was wrong, and rushed to the hospital,
where doctors did an electrocardiogram and found she was having a
heart attack. She underwent an emergency angioplasty to clear one
blockage, and subsequently had a second angioplasty and then heart
bypass surgery.
Savoie now volunteers as a speaker for the New England affiliate
of the American Heart Association. ``We want to educate women who
understand that cancer is a great risk, but don't necessarily
understand that a heart attack. . .is too.''
