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AHA: Women may experience different MI causes, symptoms than men
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The American Heart Association has issued a new scientific statement that underscores knowledge gaps in the causes, symptoms and outcomes of acute MI in women and outlines steps needed to better understand and treat CVD in women.
This release marks the first scientific statement from the AHA on MI in women. Writing group chair Laxmi S. Mehta, MD, FAHA, noninvasive cardiologist and director of the Women’s Cardiovascular Health Program at The Ohio State University, and colleagues noted that improvements in treatment, prevention and awareness in recent years have been associated with substantial decreases in deaths due to CVD. However, the annual CVD mortality rate has been higher in women than in men since 1984.
“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, especially among African-American women,” Mehta said in a press release.
Sex differences
Within 1 year of acute MI, the rate of death is 26% among women and 19% among men. Within 5 years of acute MI, the rate of death is 47% among women and 36% among men. This trend of higher mortality in women persists in the long term, according to current data.
Other differences between men and women highlighted in the report include:
- Prevalence of disease, age, race and ethnicity may all be factors in the increased acute MI rate in women.
- Women have a higher prevalence of diabetes, HF, hypertension, depression and renal dysfunction.
- Women and men exhibit differences in plaque characteristics; women tend to have plaque erosion, rather than plaque rupture.
- Microvascular disease plays a bigger role in women than in men.
- Non-STEMI and nonobstructive CAD are more prevalent in women than men.
- Spontaneous coronary artery dissection, although rare, is more common in women than in men.
- Psychosocial risk factors and stress may play a role in onset and progression of CVD in women.
- Women experience different symptoms than men. Rather than central chest pain, women may be more likely to feel pain in the upper back, arm, neck and jaw. Symptoms of fatigue, weakness, dyspnea, indigestion and nausea/vomiting are also more common in women than men.
- Guideline-recommended medications are consistently underutilized in women, leading to worse outcomes.
- Cardiac rehabilitation is prescribed less frequently for women and, when prescribed, women are less likely than men to participate or complete it.
Racial differences
Previous research has demonstrated that the age at first MI is younger among nonwhite women compared with non-Hispanic white women. Black women, in particular, have the highest rate of acute MI compared with women of all other races and ethnicities. Black women are also more likely than non-Hispanic white women to experience sudden cardiac death as the first symptom of CHD. Black and Hispanic women tend to have more CV-related risk factors such as diabetes, obesity and high BP at the time of MI compared with non-Hispanic white women. Compared with white women, black women are also less likely to be referred cardiac catheterization and other important treatments, according to a press release.
Asian Indian and American Indian women are two other high-risk groups. The CHD mortality rate among Asian Indian women increased from 2003 to 2010. American Indian women have almost two times the number of CV events compared with the general U.S. population, and three-quarters of those events occur in American Indian women with diabetes.
Increased awareness
Understanding differences in acute MI between women and men can help improve prevention and treatment, according to the statement.
“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,” Mehta said. – by Tracey Romero
Disclosure: Mehta reports no relevant disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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