February 2018

First Year After Heart Attack Deadlier for Women 

You are more likely to survive a heart attack today than if you had one 20 years ago. That’s largely because of advancements in preventing and treating heart disease. But if you are a woman, you may still have a harder time recovering. A recent study found the first year after a heart attack may be especially critical for women. 

A difference in survival

In the journal PLOS One, researchers looked at the factors that may affect survival for men versus women after a heart attack. They followed more than 4,100 heart attack victims for 5 years. A quarter of that study group were women. 

For the study, the researchers matched and compared men and women with similar risk factors for heart disease. These factors included age and overall health. They also compared other variables like treatment. They found that women and men fared about the same at 5 years of follow-up. But there was a difference in the first year after a heart attack. Women were 1.5 times more likely to die. 

The researchers found a number of reasons for this difference. The women in the study tended to be older. They were also more likely to have other health problems, such as high blood pressure, diabetes, and depression. Plus, they didn’t always receive the same types of treatment as men. 

Contributing factors

Ongoing research continues to show that women tend to fare worse after having a heart attack. Experts aren’t quite sure why. Many factors likely play a role, including older age and other health problems. 

Another key reason may be the type of heart disease. Women are more likely to have coronary microvascular disease. This kind of heart disease affects the small coronary blood vessels in the heart. The walls and lining of these vessels become damaged, limiting blood flow. This is unlike the more common coronary heart disease (CHD). In CHD, a substance called plaque builds up in the larger coronary arteries, slowing blood flow to the heart. 

Coronary microvascular disease can be harder to detect. Traditional tests used to find CHD don’t work. That’s because there are no blockages in the arteries that may point to a problem. As a result, women who have microvascular disease may not be diagnosed and treated as quickly. Such a delay may lead to more damage to the heart, making recovery harder. 

Women may also have trouble recognizing the symptoms of a heart attack. Women are less likely to have the classic sign of a heart attack: severe chest pain. They may instead feel only pressure or discomfort in the chest. It may come and go. 

Other possible symptoms to note are:

• Pain in one or both arms

• Pain in the back, neck, or jaw

• Shortness of breath

• Nausea or vomiting

• Lightheadedness

• Trouble sleeping

• Fatigue

 

Online resources

American Heart Association

Office on Women's Health