Women–Heart Attacks

When Younger Women Have a Heart Attack

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According to a new study published in JAMA,[1] younger women who seek out medical care for a myocardial infarction (MI) are more likely to present at the hospital without chest pain. Compared with men of the same age, young women are also more likely to die in the hospital following a heart attack. The researchers do note, however, that these differences become less significant with increasing age.

A Florida-based team of researchers examined the relationship between gender and symptoms of an MI when presenting to the hospital, and the risk of death while in the hospital. They ran the analysis before and after accounting for age in patients hospitalized with an MI using data from the National Registry of Myocardial Infarction, 1994-2006. Among the more than one million patients in the registry, 42% were women. The average age of the women at presentation was 74 years, while the average age of the men was 67.

Overall, the proportion of patients with documented MI who presented without chest pain or discomfort was 35.4% and was significantly higher for women than men (42% vs 31%). Among the youngest cohort of women, women were 30% more likely to present to the hospital without chest pain. This decreased to 25% for women between the ages of 45 and 65 and essentially disappeared above the age of 75.

The in-hospital mortality rate was 14.6% for women and 10.3% for men; younger women who presented without chest pain were more likely to suffer from in-hospital mortality, although this trend also reversed with increasing age. This led the authors to hypothesize that age—rather than gender—may be the more important predictor of mortality in people who present with no chest pain.

So, is this strictly a physiologic phenomenon?

While there are biological differences in younger women who have heart attacks that make such an event more deadly, some of the mortality differences are likely due a delay in both diagnosis and treatment. Overall, men and women without chest pain came into the hospital approximately two to three hours later than those who presented with chest pain and underwent EKG testing later than those with chest pain. On average, women without chest pain received fibrinolytic therapy 82 minutes after presenting at the hospital, compared with 62 minutes for men without chest pain. In general, all patients who presented without chest pain were less likely to receive aspirin, other antiplatelet agents, heparin, and beta-blocker therapies during hospitalization.

Number One Cause of Death

As heart disease is currently the number one cause of death for women in the United States[2], women who are predisposed to heart attacks because they have diabetes, a family history of heart disease, or are smokers should be reminded that a lack of chest pain does not rule out the possibility of a heart attack.

Remind patients that while chest pain is the most common symptom of a heart attack in both men and women, women often describe their chest pain as pressure, tightness, or an ache that is much less severe than traditional chest pain.[3] For this reason, women should also take mild chest pain seriously. Some women may experience symptoms as early as six weeks short of the actual event such as shortness of breath, unexplained fatigue, or stomach pain.[3] The pain is often preceded or accompanied by shortness of breath; in men, the chest pain is more often accompanied by sweating.[3] Women are also twice as likely as men to experience more “atypical” symptoms at the time of a heart attack; these symptoms include back, neck, or jaw pain, nausea, vomiting, indigestion, fatigue, dizziness, and lightheadedness.[4] But regardless of the symptoms, anyone who suspects an impending MI should call 911. Time is of the essence.

More information about heart disease in women is available through the National Heart, Lung, and Blood Institute’s The Heart Truth® campaign.


Jill Shuman, MS, ELS
Published March 13, 2012



  1. Canto JG, Rogers WJ, Goldberg RJ, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813-822.
  2. How does heart disease affect women? National Institute of Heart, Lung and Blood Institute Website. http://www.nhlbi.nih.gov/health/health-topics/topics/hdw/. Updated September 26, 2011. Accessed March 7, 2012.
  3. McSweeney JC, Cody M, O’Sullivan P, et al. Women’s early warning symptoms of acute myocardial infarction. Circulation. 2003;108(21):2619-2623.
  4. Milner KA, Funk M, Richards S, et al. Gender differences in symptom presentation associated with coronary heart disease. Am J Cardiol. 1999;84(4):396-399.