Younger women who are hospitalized for heart attacks are less likely to experience typical chest pain and face a greater risk of dying compared with men the same age, report Emory researchers in a new study out this week in JAMA.

The study involved 1.4 million patients (42 percent of them women) who experienced a heart attack between 1994 and 2006 documented in the National Registry of Myocardial Infarction. While chest pain was the most common symptom of heart attack in both women (58 percent) and men (69 percent), the study revealed that women - especially those younger than 45 years - were less likely to report chest pain and discomfort. Overall, approximately 42 percent of women with a heart attack arrived at the hospital without chest pain compared with only 30.7 percent of men. Nearly 19 percent of women under 45 who had heart attacks had no chest pain in the study compared with 13 percent of men.

The findings also showed that the absence of chest pain symptoms appeared to result in a delay in diagnosis and treatment. After entering the hospital, younger men without chest pain received their first treatment with drugs to help break up clots and restore blood flow to the heart within an average of 62 minutes, compared with an average of 81 minutes for younger women without chest pain.

In addition, researchers found that 14.6 percent of women hospitalized with a heart attack died compared with 10.3 percent of men. The gender differences were most pronounced among those younger than 55 years and declined by age 75 years. Both women and men who did not experience chest pain were more likely to die in the hospital.

	Dr. Nanette Wenger

Viola Vaccarino, MD, PhD, professor and chair of the Department of Epidemiology, Rollins School of Public Health and Nanette K. Wenger, MD, professor of medicine (cardiology) emeritus at Emory University School of Medicine were co-authors on the JAMA study.

“It is not always easy to recognize heart attacks, especially in younger women who are experiencing unusual symptoms like nausea, shortness of breath and discomfort in the jaw, back and shoulder,” says Wenger. “This study underscores the need for medical professionals and women, especially younger women, to pay attention to those atypical signs and seek medical attention immediately.”

Wenger says even though heart attacks are less common in women under 65, they are on the rise. Younger people should be on alert especially if they have risk factors like obesity, diabetes, smoking, family history of early heart disease, high blood pressure or high cholesterol levels.

“Heart muscle can be injured or die when deprived of oxygen during a heart attack,” says Vaccarino. “Time is of the essence, so these delays in diagnosis and treatment are critical.”

The study’s lead author was John G. Canto, MD, MSPH, director of cardiovascular prevention research and education at the Watson Clinic.