Major Statement on Heart Attack in Women, and a Look at Risk Based on Sex vs. Gender

February 2016

Male and Female SignEvery year for more than three decades, cardiovascular disease has killed more women than men in North America. While that gap has been narrowing, it still remains. On January 26, the American Heart Association (AHA) issued its first scientific statement on heart attack in women in the journal Circulation.

The AHA released the statement as a comprehensive summary of what the cardiovascular community knows about heart attack in women: its causes, presentation, treatment and outcomes. No matter their age, more women than men die within a year of their first heart attack (26% of women compared with 19% of men). However, women are on average older at the time of first heart attack: 71.8 years compared with 65 for men. This difference explains, in part, the higher mortality that continues to be seen in women five to 10 years after a heart attack.

Although risk factors for heart disease are shared between men and women, some factors—such as high blood pressure, and diabetes in younger women—seem to confer greater risk to women than men. Symptoms of a heart attack can also differ between women and men, a fact that many Canadian women are unaware of. Though most women do feel the typical chest pain or discomfort most people associate with a heart attack, they are more likely than men to experience only atypical symptoms, such as pain in the upper back, arm, neck or jaw; fatigue; indigestion; or nausea.

In addition to differences between men and women, the scientific statement highlights known racial disparities. For example, compared with white women, black women in the U.S. have a higher incidence of heart attack at all ages, and young black women are more likely to die in the hospital after a heart attack.

Women in general seek treatment later for a heart attack than men, which may contribute to poorer outcomes. Women are less frequently referred for appropriate treatment during a heart attack compared with men and, following a heart attack, are less likely to use guideline-recommended medical therapies. Less than 20% of women eligible for cardiac rehabilitation have participated over the last three decades, and even with a referral to rehabilitation, women participate and complete it less frequently than men.

The authors of the AHA statement hope that a more widespread understanding of these differences will help improve prevention and treatment. “Women should not be afraid to ask questions—we advise all women to have more open and candid discussions with their doctors about both medication and interventional treatments to prevent and treat a heart attack,” said lead author Laxmi Mehta, MD, in an accompanying press release.

Sex, Gender and the Risk for Heart Disease

nullThe terms sex and gender are often used interchangeably, but they have different meanings. According to a new study from McGill University, that difference is relevant to a person’s risk for heart disease.

Sex refers to the concrete biology and physiology that define men and women. The concept of gender is much more fluid and may be influenced by cultural factors and roles and identity in society and interpersonal relationships. Women can possess gender traits traditionally associated with men and vice versa.

The study, published recently in the Journal of the American College of Cardiology, found that the risk for recurrence of cardiovascular disease was associated with feminine roles and personality traits, but not female sex.

The researchers administered detailed surveys to more than 900 young Canadians (ages 18 to 55) being followed for a year after experiencing acute coronary syndrome (ACS). Variables measured included employment, number of hours worked per week, level of responsibility for child care and child discipline, time spent on housework, and stress level at work, home and overall.

Scores from the surveys were then used to divide participants into three equal groups: those with the most gender-related characteristics traditionally ascribed to men; those with characteristics more or less equally ascribed to women and men; and those with the most gender-related characteristics traditionally ascribed to women.

While the rate of ACS occurrence was the same between men and women (3% for each), when split by gender score, participants with the most gender-related characteristics traditionally ascribed to women had a 5% rate of ACS occurrence compared with only 2% in the other two gender groups, a statistically significant difference.

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