Most Young Women Don't Recognize Heart Attack Warning Signs

Women younger than 55 years represent less than 5 percent of all hospitalized heart disease patients, but because so many heart attacks occur in the United State each year, even this small percentage affects a large number of people. Young women with heart disease account for about 40,000 hospitalizations each year. Diseases of the heart in young women account for about 16,000 deaths annually, ranking it among the leading causes of death in this group, according to authors.

"The number of young women who die from coronary heart disease each year is roughly comparable to the number of women who die of breast cancer in this age group," said Judith Lichtman, Ph.D., lead author of the study. "Studies have shown that young women with heart disease are twice as likely to die in the hospital as similarly aged men. While these statistics are startling, relatively little is known about the clinical presentation, care or outcomes of young women with heart disease."

In a pilot study, Lichtman and colleagues studied 24 women (55 and younger) who had heart attacks and were admitted to one of two Connecticut hospitals. The researchers asked them about their symptoms before the heart attack and whether they recognized or understood that they were at risk for heart disease.

Nearly 90 percent of the women in the study had the typical heart attack symptom of chest pain, with 7.4 being the average rating of their chest pain on a scale of one to 10 (with 10 being the most painful).

"This means that they were experiencing significant chest pain," said Lichtman, an assistant professor in the Department of Epidemiology and Public Health at Yale School of Medicine in New Haven, Conn. Researchers said they were surprised that only 42 percent, or four in 10, of the women who came into the hospital thought something was wrong with their hearts. "Many of them told us that they thought they had indigestion or heartburn," Lichtman said.

The women also reported other less typical symptoms:

• 58 percent said they had pain in the jaw or shoulder
• 38 percent reported sweating
• 29 percent experienced nausea
• 29 percent reported shortness of breath
• 21 percent said they had indigestion or heartburn
• 8 percent felt weakness or fatigue

Only about half of the women went to an emergency room within the first hour of their symptoms.

"When we asked the women why they delayed going to the hospital, half of those who waited more than an hour said they were afraid their symptoms weren't real; about 42 percent attributed their symptoms to something else; about 17 percent said they were embarrassed by their symptoms; and 8 percent admitted that they feared the symptoms or experienced denial that it could be heart disease," Lichtman said.

The researchers also found that about 88 percent of the women had a family history (a parent or sibling) with heart disease. Even though 71 percent said their health was fair/poor, less than half considered themselves at risk for heart disease.

The researchers said doctors may be failing to link many young women's symptoms to heart disease. Prior to their heart attacks, 38 percent saw their primary providers for some or all of their symptoms; yet, only 56 percent of those women said their doctors told them their symptoms were heart-related.

"It seems that many young women are not connecting their symptoms with heart disease, even more are simply unaware of the possibility that they are at risk for a heart attack," Lichtman said. "We have to get the messages across to young women that they are at risk for a heart attack, they might experience not only typical but also atypical symptoms, and they need to be aware of their own risk factors, including family history. Prevention and modification of risk factors is important for young women. "

To avoid possible permanent damage to the heart muscle, young women, like their older counterparts, must seek prompt care if they have symptoms. They also must be persistent with their health providers -- especially if they have risk factors, including high blood pressure, high cholesterol, obesity, smoking, inactivity, diabetes and family history, Lichtman said.

Co-authors are Norrina B. Allen, M.P.H.; Emi Watanabe, M.P.H.; Zhenqui Lin, Ph.D.; Stuart Zarich, M.D., Barbi H. Hart, R.N. and Harlan M. Krumholz, M.D.