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Women have much higher risk of dying after heart attack than men, study finds

New research suggests that women may be more than twice as likely to die after a heart attack compared to men. Here's what to know about heart attack symptoms in women.
/ Source: TODAY

Cardiovascular disease is the leading cause of death among men and women worldwide. A new study suggests that women may be more than two times more likely to suffer adverse outcomes, including death, after a heart attack compared to men of a similar age.

Researchers in Portugal found that women hospitalized for heart attacks had a higher risk of short-term and long-term mortality, as well as future cardiovascular events, compared to their male counterparts, Dr. Mariana Martinho, study author and cardiologist at Hospital Garcia de Orta in Almada, Portugal, tells

The findings were presented at Heart Failure 2023, a scientific congress of the European Society of Cardiology. "We are currently writing the manuscript to publish the article in a peer-reviewed scientific journal," says Martinho.

According to Martinho, the data highlight the need for increased awareness of heart attack outcomes in women. "Women of all ages who experience a myocardial infarction are at particularly high risk of a poor prognosis," Martinho adds.

A heart attack, also known as myocardial infarction, occurs when the flow of blood to the heart is reduced or stopped. The main cause is coronary artery disease, a common type of heart disease, per the U.S. Centers for Disease Control and Prevention.

The retrospective observational study included 884 patients admitted to the hospital between 2010 and 2015 with ST-elevation myocardial infarction, or STEMI, a type of heart attack that occurs when the one of the heart's main arteries supplying it with blood is completely blocked. It's a more serious type of heart attack and carries a higher risk of complications and death, per the Cleveland Clinic.

All patients in the study were treated with percutaneous coronary intervention, says Martinho, a procedure where a tube or stent is used to open up the artery and restore blood flow to the heart.

Women were twice as likely to die after a heart attack than men, data show

The researchers looked at long-term and short-term outcomes — including mortality after 30 days and five years, as well as adverse cardiovascular events within five years — and examined differences in both pre-menopausal (under 55) and post-menopausal (55 and older) women compared to their male counterparts.

After adjusting for risk factors and other health conditions, Martinho and her colleagues found significant differences in outcomes. After 30 days, 11.8% of women studied had died compared to 4.6% of men and after five years, nearly one-third of women (32.1%) had died versus 16.9% of men, per the study authors.

The researchers also found that 34% of women experienced a major adverse cardiovascular event within 5 years of their heart attack compared to 19.8% of men.

“Women had a two to three times higher likelihood of adverse outcomes than men in the short- and long-term, even after adjusting for other conditions and despite receiving (percutaneous coronary intervention) within the same timeframe as men,” Martinho said in a European Cardiovascular Society press release.

Researchers conducted another analysis focused on patients with risk factors for heart disease, such as diabetes and high blood pressure. They compared the outcomes for men versus women under 55 with the same type of risk factor, as well as those over 55.

Based on this analysis, which looked at 435 people, "postmenopausal women had worse short- and long-term outcomes after myocardial infarction than men of similar age,” says Martinho.

Premenopausal women (under 55 years of age) had similar short-term mortality to men of a similar age but a poorer long-term prognosis, she adds. At five years, 20% of women had experienced a major adverse cardiovascular event compared to 5.8% of men.

Researchers also found that women under 55 had a “significantly longer treatment delay after arriving at the hospital” compared to their male peers (95 minutes versus 80 minutes).

The findings of this study contribute to a growing body of evidence about discrepancies in the recognition and treatment of heart disease among women, experts note.

“It's clear that this is an issue. ... Different studies have shown that women tend to have worse outcomes,” Dr. Sonia Tolani, associate professor of medicine and co-director of the Women’s Heart Center at Columbia University Irving Medical Center, tells Tolani was not involved in the new research.

Although it has been historically perceived as a “man’s problem,” heart disease is the leading cause of death among women in the United States, according to the CDC.

The study did not examine reasons for the differences in adverse outcomes between men and women after a heart attack, but there are a few potential factors.

"Women usually have (cardiovascular events) when they are older and have more co-morbidities (like diabetes or high blood pressure). These are two possible explanations for their worse prognosis," says Martinho. Another possible factor is that women more frequently present with atypical symptoms of a heart attack.

Women heart attack symptoms

Heart attacks don’t always look or feel like the dramatic, chest-clutching depictions you see on television or in movies. Although chest pain is still the “No. 1 complaint” among both male and female patients, says Tolani, women are also more likely to have symptoms that don't include chest pain, such as:

  • Shortness of breath
  • Nausea or vomiting
  • Dizziness
  • Pain in one or both arms
  • Pain in the back, neck or stomach

"It is important to recognize these other symptoms as potential acute (heart attack) symptoms, particularly if they appear suddenly and do not resolve with rest," Martinho says. However, it may still take longer for women to do so or to seek medical assistance, she adds.

"There’s also this cultural idea that women are always taking care of everybody else. ... They’re more likely to try to power through and get all their ducks in a row before they seek care,” says Tolani.

Even when women do present with traditional chest pain or seek care immediately, they may not receive treatment as quickly. “Some studies suggest that physicians take longer to diagnose and treat the myocardial infarction (in women),” says Marintho.

Misconceptions about heart disease in women exist among the general public and physicians alike, previously reported.

“Truth be told, a lot of women are coming in with typical symptoms and still getting the delay in treatment, so I don’t think it can all be explained by the idea that women present slightly differently,” says Tolani.

The time between symptom onset and the first EKG, which could diagnose a heart attack or another heart condition is critical, says Tolani. "If somebody has the (STEMI) heart attack, the thing that will make the most impact is how quickly they get that artery open,” says Tolani, adding that any delay, even only 15 or 20 minutes, can make a difference in the recovery of the heart muscle.

All these factors combined may contribute to women having more severe disease when they arrive at the hospital and not getting as prompt treatment as men, says Martinho, which can eventually lead to higher rates of heart failure and death, she adds.

"There are two main areas where we can intervene," says Martinho. The first is promoting awareness of potential heart attack symptoms in women, she says, and the second is ensuring health care providers are treating patients as quickly as possible and following up with rigorous cardiovascular risk control and rehabilitation.

About "80% of heart disease can be prevented by taking care of risk factors, whether it's quitting smoking, exercising regularly, cholesterol and blood pressure management," explains Tolani.

What's more, heart disease rates have been rising in younger women, between 35 and 55, she says.

"The findings are another reminder of the need for greater awareness of the risks of heart disease in women," says Martinho, adding that more research is needed to understand why there is a gender disparity in prognosis after heart attacks so steps can be taken to close the gap in outcomes.