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Younger Women Fail to Heed Heart Attack's Warning Signs

Focusing on chest pain may not be enough, experts warn

THURSDAY, May 10, 2007 (HealthDay News) -- Women under the age of 55 often fail to recognize the symptoms of a heart attack until it's too late, a new study warns.

Ignoring those signs -- which can include anything from chest pain to nausea -- can delay medical care and increase risks for disability and even death.

"Women of this age range, when they go into the hospital with heart disease or a heart attack, their likelihood of dying from that event is two times that of a man," noted Dr. Suzanne Steinbaum, director of Women & Heart Disease at Lenox Hill Hospital in New York City. "Heart disease in young women is a very, very aggressive disease, and it needs to be addressed early and aggressively."

But experts also cautioned that the study was a small one, and that the subject also needs more research.

"We can't make conclusions with 24 patients," said Dr. Nieca Goldberg, medical director of the Women's Health Program at New York University Medical Center and author of The Women's Healthy Heart Program. "I think we need to learn more about the range of symptoms."

The findings were expected to be presented Thursday at the American Heart Association's scientific forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, in Washington, D.C.

Heart disease among women is widespread, accounting for one in three female deaths, experts say.

Although women younger than 55 years make up less than 5 percent of all hospitalized heart disease patients, this is still a large number of women, according to the AHA. Young women with heart disease account for about 40,000 hospitalizations each year and 16,000 deaths.

The number of younger women who die from coronary heart disease each year is about equivalent to the number of women who die of breast cancer in the same age group, the association says.

"Women in this age group may not think they're really at risk, because we mostly hear about older women," said study author Judith Lichtman, an assistant professor of epidemiology and public health at Yale University School of Medicine. "But while it's a relatively smaller group, it's not an insubstantial group."

For this pilot study, researchers interviewed two dozen women aged 18 to 55 who had had heart attacks and were admitted to one of two Connecticut hospitals. Three-quarters of the women were white, and 88 percent had a family history of heart disease.

The vast majority (88 percent) reported traditional symptoms of severe chest pain. Yet only 42 percent suspected something was wrong with their heart.

"The chest pain was an average score of 7.4 [on a scale of one to 10], which is not insignificant," Lichtman said.

Less typical symptoms included pain in the jaw/shoulder area (experienced by 58 percent of the women); sweating (38 percent); nausea (29 percent); shortness of breath (29 percent); indigestion (21 percent) and weakness/fatigue (8 percent).

"In this young population, we're seeing a very high prevalence of traditional as well as atypical symptoms," Lichtman said.

Focusing only on chest pain could cost lives, Goldberg warned. Other studies have shown that women often have symptoms other than chest pain.

Only half of the women in this study sought care within the first hour, apparently because they thought their symptoms weren't real or weren't serious. Forty-two percent of participants thought their symptoms were something other than a heart attack; 17 percent said they were embarrassed by the symptoms; and 8 percent said they were afraid the symptoms were due to a heart condition.

Almost three-quarters (71 percent) of the women characterized their health as either just fair or poor, yet less than half believed they were at risk for heart disease.

Both patients and doctors may be failing to connect the dots, the experts said. Just over one-third (38 percent) saw their primary provider for symptoms prior to having a heart attack. And only 56 percent of the women said their doctors said their symptoms were heart-related. And this was among a group of women almost all of whom had a family history of heart disease.

"This is really the first time research has focused on women aged less than 55," Steinbaum said. "The writing is on the wall. Don't attribute it to something else."

In related news, a second presentation at the same meeting found that patients with a hemorrhagic ("bleeding") stroke are significantly less likely to receive medications such as cholesterol-lowering drugs and counseling to prevent recurrent strokes compared to patients with an ischemic (clot-caused) stroke.

More information

The American Heart Association's Go Red for Women campaign has more on women and heart disease.

SOURCES: Judith Lichtman, Ph.D., assistant professor, epidemiology and public health, Yale University School of Medicine, New Haven, Conn; Suzanne Steinbaum, D.O., director, Women & Heart Disease, Lenox Hill Hospital, New York City; Nieca Goldberg, M.D., medical director of the Women's Health Program at New York University Medical Center and author of The Women's Healthy Heart Program: Lifesaving Strategies for Preventing and Healing Heart Disease in Women; May 10, 2007, presentation, American Heart Association's 8th Scientific Forum on Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke, Washington, D.C
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