Why Younger Women Are Having More Heart Attacks: It's Not Just A Man's Disease

KERA | By Sam Baker

Published March 11, 2019 at 6:40 AM CDT

Chest pain's a common sign of heart attack, but women often don't have the usual symptoms.

A recent study found younger women – 35 to 54 – are having more heart attacks. They accounted for nearly a third of all female heart attack patients in recent years.

Dr. Sreenivas Gudimetla, a cardiologist with Texas Health Fort Worth and Texas Health Physicians Group, says the problem stems in part from America's ongoing epidemic of obesity.

“Obesity leads to diabetes and hypertension,” he said. “There was a British Medical Journal study which showed that hypertension raised the risk of a heart attack in women 83 percent more than in men. Type 2 diabetes mellitus raised the risk of a heart attack in women 47 percent more than in men.”

But Dr. Gudimetla also points to lack of awareness as a major challenge. Women don’t always have the same classic symptoms for heart attack as men like chest pain or pain up and down the arm. So when women complain of shortness of breath or fatigue, some doctors tend not to check for heart disease.

Add to that, the general thought that younger women don’t get heart disease.

"But I think, the past 20 years or so, things are changing,” said Gudimetla. “With education, changes in thinking, I believe we are headed in the right direction, but we’re not where we need to be yet.”

Obesity as a factor: “The CDC actually has great data on this. As you go year by year from the mid 1980s or so to the present, in most states – especially in the South – there is a 35 or greater percent incidence of obesity in the general population. Obesity leads to diabetes and hypertension. There was a British Medical Journal study which showed that hypertension raised the risk of a heart attack in women 83 percent more than in men. Type 2 diabetes mellitus raised the risk of a heart attack in women 47 percent more than in men.”

Women don’t receive the same heart attack care as men: "It was believed many years ago, and certainly when I went to medical school, that women – and especially younger women – actually had protective effects from estrogen, for instance, which was believed to reduce the risk of heart attacks in women. That sort of got disproven in the late 1990s. There was a lot of misinformation out there before."

Another challenge: "Women typically don’t present with the classic symptoms of a heart attack. Sometimes, women may not have chest pain. They may complain of shortness of breath. They may complain of fatigue alone. And so when women present to the emergency room feeling a little bit tired, a little bit of nausea, for many physicians out there, heart disease is not the first think that comes to mind. So they’ll do an initial evaluation. They may or may not check cardiac enzymes. And then they’ll send them home and they can follow up with their regular doctor."

It’s a man’s disease: "There’s a significant delay in diagnosis because the clinical suspicion for the provider is not high enough. The symptoms are a lot more non-specific to where it doesn’t trigger a workup. And there’s a general thought that young women don’t get heart disease. It’s has been that way for many years. But I think, the past 20 years or so, things are changing. People – providers, physicians, other healthcare providers – are being much more aware that heart disease needs to be considered more in women than has been in the past. With education, changes in thinking, I believe we are headed in the right direction, but we’re not where we need to be yet."

Solutions? "I think it is very important to educate everybody in the medical community to always consider heart disease in women. The fact of the matter is when a young woman presents to you and they have diabetes, they have hypertension, they’re overweight, those are risk factors for heart disease. They smoke – that’s another risk factor for heart disease. So, anytime you assess somebody in general, you look at their risk factor profile and that should direct you to think about it and do the right diagnostic testing to ensure safety in women."

What younger women should do: "Start taking care of yourself and start doing the right things when you’re young. When you’re growing up as a child. Start developing the right habits. Parents need to educate your children to learn good health habits so that if they take good care of themselves then, that is going to make the biggest difference in reducing cardiovascular disease risk in the future."