Study: Heart pain less likely in women

Women heart attack victims are more likely than men to arrive at the hospital without chest pain but are more likely to die once admitted, according to a new study.

Gender differences involving heart attack symptoms have long been debated by medical investigators who have found evidence for two arguments: One, that heart attack symptoms differ in women, and the other that their symptoms are no different from those of men.

But last week in an observational analysis of both sexes, researchers reporting in the Journal of the American Medical Association found that women don't always experience chest pain.

Statistics involving 481,581 women and 661,932 men were examined as part of the analysis. They were gleaned from a database of heart attack patients, the National Registry of Myocardial Infarction.

Proportionately, the percentage of women arriving at hospitals without chest pain was significantly higher: 42 percent versus 30 percent of men.

In addition, almost 15 percent of women died once admitted to the hospital compared with 10 percent of men.

Parsing the data further, Dr. Suzanne Steinbaum, who was not involved in the research, said it also showed a difference in symptoms among women based on age.

"Women younger than 55 were less likely to present with chest pain compared to older women," said Steinbaum, director of Women and Heart Disease at Lenox Hill Hospital in Manhattan and spokeswoman for the American Heart Association.

"This study reveals that the mechanism of heart attacks may be different in younger women as well, with inflammation, coronary spasm, plaque erosion and hypercoagulability being the greatest causes," Steinbaum said. Hypercoagulability refers to blood coagulating more rapidly than normal.

Classic heart attack symptoms, according to Dr. John Canto of the Watson Clinic and Lakeland Regional Medical Center in Florida, who led the research, include chest pain or discomfort and sensation or pressure -- tightness -- in the chest, arm, neck or jaw.

The study did not list nonclassic symptoms, but earlier studies have found them to include nausea and vomiting, upper back or neck pain, shortness of breath and feeling faint. The problem with nonclassic symptoms, Canto and his colleagues said, is the failure of patients to seek immediate treatment.

Yet, even though the study demonstrated a gender difference in heart attack symptoms, Dr. Richard Shlofmitz of St. Francis Hospital in Flower Hill cautioned against accepting that notion as a rule.

"I have taken care of equal numbers of men and women, and a majority have similar symptoms," said Shlofmitz, who chairs the department of cardiology.

"It's possible that women are more stoic and do not present for treatment as soon as men. But I can't think of a rational medical reason why there would be a difference."

Canto and his team found that the risk of dying once hospitalized decreased with age for women. Those who were 65 and older were less likely to die than men the same age.

More than 1 million people in the United States suffer heart attacks annually, and half die as a result, according to the National Heart, Lung, and Blood Institute.