ShareThisHeart disease is the number one killer of both men and women.
But conventional wisdom has been that older men die of heart attacks, while women die of old age.
For several decades, medical science has been playing catch-up with women and an almost silent epidemic of heart disease, working under the assumption that it typically occurs at an older age, with more complications and different symptoms in females.
Even underdiagnosed and undertreated, women historically have tended to survive initial heart attacks better than men, many studies have shown.
Those assumptions may be oversimplified, however.
Several new studies published in late October suggest that heart attacks in middle age are not so different between women and men, although outcomes may still favor women.
One Canadian study found that heart attack symptoms described by men and women may not be as distinct as thought.
Martha Mackay, a cardiac nurse and Canadian Institutes of Health Research fellow, lead a team that studied 305 consecutive patients undergoing angioplasty -- a procedure to open arteries leading to the heart that briefly causes symptoms similar to a heart attack.
They found no gender differences in the rates of chest discomfort or other "typical" heart attack symptoms like arm discomfort, shortness of breath, sweating, nausea, indigestion symptoms and clammy skin.
The major difference was that women were more likely to have those classic symptoms plus discomfort in the throat, jaw and neck.
Mackay says the findings suggest that doctors, particularly in the emergency room, perhaps need to step back from the idea that female heart attacks present different symptoms and spend a bit more time asking questions about symptoms.
Many women experience pain differently from men and are still more likely than men to discount the possibility that what's causing their chest discomfort is a heart attack rather than indigestion, asthma or some other medical problem.
"Where women are concerned, some extra probing could result in a speedier and more complete diagnosis," Mackay said.
Another study, based on surveys of heart health done between 1988 and 2004, found that heart attacks among women under age 55 have become more common in recent years, while they have declined slightly among men in that age group.
At the same time, the surveys showed many cardiac health markers, including cholesterol levels, blood pressure and smoking rates declined for men, but were up or steady among women.
Researchers at the University of California, Los Angeles, noted in the Archives of Internal Medicine that another recent report also showed women had higher rates of stroke than men in a representative sample.
Equality in various heart risk factors, particularly obesity, may be to blame, they said.
At the same time, a study of in-hospital deaths among heart attack patients between 1994 and 2007 found that rates decreased among both sexes at all ages, but were most pronounced in women younger than 55, for whom the risk of death fell almost 53 percent, compared with 33 percent for men of the same age.
Dr. Viola Vaccarino, of Emory University School of Medicine, said most of the change seems to be because women with heart attack symptoms now have a lower risk status than men when they are admitted to a hospital.
In other words, doctors and their patients seem to be catching on to the notion that heart disease is a danger as much for middle-aged women as for middle-aged men, and they're starting to take preventive steps earlier and more aggressively. And since many women tend to be more engaged in managing their health compared with men, they're reaping survival benefits.
(Contact Lee Bowman at BowmanL(at)shns.com)
MEDICAL JOURNAL
