Why Are Women More Apt to Die After a Heart Attack Than Men?

Their symptoms are often different, and an emergency response is sometimes slower.

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When contrasting all men with all women who are admitted to the hospital with a diagnosis of a heart attack, women are generally much older and have more comorbidities, or additional illnesses, than men. That's the major reason for the sex difference overall.

When comparing age-matched men and women, the differences are minimal among older adults (ages 70 and over); younger women, meanwhile, fare much more poorly than men. The reasons include differences in the symptoms of a heart attack—i.e., men are much more likely to experience chest pain and what many of us learn about in CPR, whereas women have a wider, more diffuse range of symptoms, including indigestion and pain radiating in other areas of the body. These signs are less readily recognized by both the patient and the medical professional as a heart attack. Thus a woman often does not call 911 or head to the emergency room as quickly as a man, and a physician is more likely to send a woman off from a clinic visit without appropriate treatment.

Additional "gendered" medical disparities include a slower emergency medical response for a woman; a 911 call has a longer delay before an ambulance arrives at the scene for a woman versus a man. And once a woman reaches the emergency room, it often takes longer before she receives recommended cardiological treatments, such as a balloon angiogram. There may also be physiological reasons, in addition to those that produce different symptoms; however, these have not been well investigated. The Women's Ischemic Stroke Evaluation study focused on reasons women with chest pain often do not have occluded (blocked) arteries and suggested that the underlying pathology of microvascular disease may be more common in women; however, as there were no men in that study, one could not confirm that it was a sex difference. Clearly, much more work is needed to answer this question.

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