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Why More Young Women are Having Heart Attacks

June 24, 2019

As more and more young women – particularly of color – experience high blood pressure, diabetes and obesity, they are having heart attacks at an alarming rate.

According to a study in Circulation, the journal of the American Heart Association, the number of acute myocardial infarctions, or heart attacks, in young women jumped 27 percent to 32 percent in the past few years, based on research by the Atherosclerosis Risk in Communities Surveillance Study.

Young women were more likely to have a heart attack than were young men, and young African American women were even more likely due to higher rates of hypertension, chronic kidney disease, diabetes and other conditions.

Dr. Melissa Ferraro-Borgida — a cardiologist at Cardiology, PC, and part of the Hartford HealthCare Heart & Vascular Institute — said she’s seen the increase in her own practice, attributing it to lower activity levels, poor diets and lack of public education regarding risks in young women.

Healthcare providers, she added, tend to underestimate risks in younger women even though they tend to have more simultaneous conditions such as diabetes and high blood pressure than do men when they have their heart attacks.

“The medical community might not be reacting to symptoms because young women have traditionally been considered low risk. As a result, young women at risk are less likely than men to be prescribed medications for high cholesterol and blood pressure,”Dr. Ferraro-Borgida said, adding that a previous study indicated providers need to “rethink our estimations of risk in female patients as we are likely undertreating risk factors until later in life.”

“Cardiovascular disease is the leading cause of death in women,” she said. “We need to educate younger females and providers. Prevention should start in adolescence with tight control of cholesterol, hypertension and diabetes and prevention of these conditions through education regarding diet and exercise.”

Psychosocial and socioeconomic stressors burden many African American women with increased chances of such conditions as high blood pressure, diabetes, chronic kidney disease and stroke, Ferraro-Borgida noted.

The Circulation study further revealed that the type of heart attack young women have differs from those affecting young men, as does the type of treatment provided.

“Women are less likely to have arteries completely blocked with specific electrocardiogram changes that lead to an urgent trip to the catheterization lab,” Ferraro-Borgida noted. “They tend to have more diffuse artery disease that elevates cardiac enzymes but shows nothing on an electrocardiogram so they are sent less often to a cath lab for intervention.”

If a woman is sent for procedures to open clogged arteries, doctors often cannot find a lesion to stent, however these women have just as much risk for future heart attacks as their male counterparts.

“Young women more often have one or more coronary arteries tear, causing chest pain, electrocardiogram changes and damage to the heart,” Ferraro-Borgida said. “This is the most common cause of [heart attack] in pregnancy but it occurs in non-pregnant women as well. Stenting is less common with this type of heart attack because interventions in the coronary arteries can worsen tears.”

The good news, Ferraro-Borgida said, is that understanding is evolving when it comes to heart attacks in women, who experience different symptoms for AMI, a disruption in blood flow in the heart.

“Prior studies included far more men than women and led to a bias in the medical community of men’s symptoms being labeled ‘typical,’” she said, noting that men experience crushing chest pressure but women often experience just shortness of breath and fatigue without “typical” chest pain.

Signs of heart attack in both men and women include:

  • Chest pressure
  • Discomfort in the back, neck, jaw or arms
  • Sweatiness
  • Nausea
  • Fatigue

“If a person is experiencing symptoms, the faster they seek emergency medical attention, the more heart muscle can be saved in a true heart attack,” she said.

For more information on help at the Hartford HealthCare Heart & Vascular Institute for heart disease in men or women, click here.