September 30, 2020
Young women are more likely than men to die of cardiogenic shock, a deadly heart attack complication, despite the condition being more prevalent in men.
This gender disparity may be the result of young men being more likely to receive aggressive tests and treatments, a new study suggests. But it also speaks to greater issues regarding heart disease: Many doctors miss the subtle heart attack signs that women experience and so much research has been based on men.
Cardiogenic shock occurs when the heart is unable to pump enough blood to maintain heart function. It is the leading cause of death after a heart attack.
In the study, women ages 18 to 55 were 11% more likely to die from cardiogenic shock in the hospital than men of similar ages.
Women were less likely to undergo coronary angiography to detect blockages in heart arteries, be given stents or balloons to open blocked heart arteries, and receive temporary assistance from a mechanical heart pump. They also were less likely to receive an angiography on the day they were admitted to the hospital.
According to Melissa Ferraro-Borgida, a cardiologist with Hartford Health Care Heart & Vascular Institute who wasn't involved in the study, this could be because women are less likely to have arteries completely blocked. More diffuse artery disease will not show up on an electrocardiogram, she said.
Women often experience more subtle symptoms during a heart attack, researchers said. This leads many to shrug off serious signs as normal aches and pains.
Instead of the sharp pain or pressure in the chest that is typically associated with a heart attack, many women will report shortness of breath, indigestion, pain in the upper abdomen, dizziness, lightheadness, upper back pain or pressure and extreme fatigue.
Plus, doctors are known to miss heart attack signs in women, too. It happens as much as 50% of the time, according to a 2018 study.
Missed diagnoses and differences in care are related to the "unconscious or conscious" biases of doctors, health care systems and family members, according to lead researcher Saraschandra Vallabhajosyula, a clinical fellow in interventional cardiology at Emory University School of Medicine in Atlanta.
Vallabhajosyula told U.S. News & World Report that in order to eliminate these disparities, doctors first need to recognize they exist. Too much of what doctors know of heart disease is based on the average middle-aged white man, he said.
"We all know that is not true anymore," Vallabhajosyula said. "All subgroups are prone to different kinds of symptoms, so just recognition of the textbook description of symptoms is not true."
The study also found that Black women had more heart attacks with cardiogenic shock than men or white women. Women were more likely to suffer from co-morbidities or be admitted to a rural or smaller hospital. They also were more likely to come from poorer, less educated families.
These delays in diagnosis and treatment are especially concerning considering the spike in younger women suffering heart attacks in the last few years. A 2019 study found that they increased 27% in just a few years.
This increase is due to women developing chronic health conditions like hypertension, kidney disease and diabetes, at earlier ages, cardiologists say. Poor diet, lack of exercise and lack of public education about the risks in young women also are contributing factors.
Women should never downplay any health concerns they have, Vallabhajosyula emphasized. He encouraged them to listen to their bodies and seek the help they need.
Women who experience any of these signs or symptoms should call 911 immediately:
• Uncomfortable pressure or a squeezing sensation in the center of the chest. It may come and go.
• Pain or discomfort in one or both arms, the back, neck, jaw or stomach
• Shortness of breath with or without chest discomfort
• Breaking out in a cold sweat, nausea/vomiting or lightheadedness
The study, which included more than 90,600 U.S. men and women who suffered cardiogenic shock after a heart attack, was published online Tuesday in the journal Circulation: Heart Failure.
All data came from the Agency for Healthcare Research and Quality's National Inpatient Sample from 2000 to 2017. The researchers acknowledged that the percentage differences between the sexes was small. But they added that in a large sample like theirs, those differences affected many people.