Women who are hospitalized for a heart attack are less likely to experience chest pain and are more likely to die than men the same age, researchers said.
The analysis published in the Journal of the American Medical Association is the largest to examine the interplay among gender, age and chest pain when it comes to death from heart disease, the leading killer worldwide. Chest pain is the hallmark symptom of a heart attack, according to researchers who suggested its absence might help explain women’s increased risk.
The study examined the records of 1.1 million Americans from 1994 to 2006 in the National Registry of Myocardial Infarction, the largest database of heart-attack patients in the world. Forty-two percent of women reported no chest pain when they were hospitalized for a heart attack, known medically as a myocardial infarction, compared with 30.7 percent of men. Almost 15 percent of the women died, compared with 10 percent of men.
“Our data suggest that the absence of chest pain is associated with increased mortality, especially among younger women,” said the researchers, led by John Canto, from the Watson Clinic and Lakeland Regional Medical Center in Florida. “Patients without chest pain and discomfort tend to present later, are treated less aggressively and have almost twice the short-term mortality compared with those presenting with more typical symptoms.”
The excess risk of dying in the hospital for women who weren’t experiencing chest pain decreased with age, as the oldest women were less likely to die than men the same age who also weren’t suffering the tell-tale signs of a heart attack.
Chest pain and discomfort were still the most common symptom among those hospitalized for heart attacks, and they should be emphasized in public education campaigns, the researchers said. The finding that the absence of chest pain may help predict the risk of death is “provocative,” and should be confirmed by additional studies, they said.
More than 1 million Americans suffer heart attacks each year, and half die as a result, according to the National Institutes of Health. The report didn’t determine what other symptoms heart-attack patients were having that led them to the hospital, the researchers said. Previous studies show women in particular may experience pain in the upper back or neck, indigestion, nausea, extreme fatigue and shortness of breath.
Roche Holding AG’s Genentech unit funded the National Registry of Myocardial Infarction and approved the final manuscript of the paper. It didn’t play a role in the design, management or analysis of the study.