Heart attack remains understudied, underdiagnosed and undertreated in women

Cardiovascular disease is the leading cause of death for women in the U.S. and globally. The death rate remains higher for women than men and, despite advances, coronary heart disease remains understudied, underdiagnosed and undertreated in women. Women’s heart health experts at The Ohio State University Wexner Medical Center are leading the effort to improve awareness, prevention, recognition and treatment in women with heart disease.

“Over the last 10 years or so, we’ve learned that women’s hearts are different than men’s in some significant ways, and while that’s helped reduce mortality, there’s much more to know,” said Laxmi Mehta, MD, director of Ohio State’s Women’s Cardiovascular Health Program. “Most heart disease research is done in men, so how we categorize it is based on men. We need more science in women.”

A scientific statement issued by the American Heart Association underscores knowledge gaps that remain when it comes to women and heart attacks, and outlines the priority steps needed to better understand and treat heart disease in women. The statement, chaired by Dr. Mehta, compiles the newest data on symptoms, treatments and the types of heart attacks among women.

“We hope having one place for medical professionals to access the current data available on heart attacks in women encourages more work to implement change and close the knowledge gaps that remain,” Mehta said.

Heart attack symptoms for women

While men and women both experience chest pain as a primary heart attack symptom, women often have atypical, vague symptoms without the usual chest pain, such as palpitations, pain in the back, shoulder or jaw, even anxiety, sweating or indigestion. Some women may only experience shortness of breath, nausea, vomiting or flu-like symptoms.

In addition, delay in seeking treatment is more common among women than men. Several factors can lead to a delay in seeking help, including living alone, interpreting symptoms as temporary or not urgent, consulting with a doctor or family member first, and fear of embarrassment if the symptoms aren’t serious.

Causes of heart attack in women

There are also sex specific differences in causes of heart attacks. Most are caused by a blocked coronary artery. However, women can frequently have no significant blockage, or have other types of heart attacks. An intense spasm in the artery can abruptly decrease blood flow to the heart. Women also experience spontaneous coronary artery dissection, or a tear in the artery, more often than men do.

Social, environmental and community differences also play a role in how women’s heart attack treatment outcomes differ from men’s. More women have depression related to heart disease, which can hinder their treatment. Women less often complete cardiac rehabilitation due to competing work and family responsibilities and lack of support.

Certain cardiovascular risk factors are more potent in women, including type 2 diabetes and high blood pressure. There is also growing evidence that emotional stress and depression can influence the onset and course of heart disease in women.

“We don’t yet clearly understand why women have different causes and symptoms of heart attacks,” Dr. Mehta said. “Women are more complex, there are more biological variables such as hormonal fluctuations. That’s why more research is needed.”

Learn more about the services offered at our Women's Cardiovascular Health Clinic. To schedule an appointment with our women's cardiology experts, call 614-293-7677.

Women’s heart care at Ohio State

The Women’s Cardiovascular Health Clinic at Ohio State’s Wexner Medical Center is one of only a handful of clinics in the country devoted to women’s heart health.

We provide a thorough risk assessment for all women who choose Ohio State for care. Our team will provide you with an individual care plan and will connect you with all the services you need, from lifestyle counseling to medications, surgery and cardiac rehabilitation.

Our women’s heart health experts are currently pursuing research in areas such as stress testing for women, role of hormones in heart disease, and heart attack mortality rates in women versus men. One of the first steps to help improve outcomes for women is to increase participation in cardiovascular research trials. Find out how you can become involved in women’s heart research studies at Ohio State.

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