November 26, 2013
News Review From Harvard Medical School -- Study: Chest Pain Similar for Women, Men
A new study finds that most men and women have similar chest pain or discomfort when they are having a heart attack. But there are other conditions that can cause chest pain. The study did not find any details about the type of pain that could help doctors tell whether a heart attack is the cause. The study included about 800 women and 1,700 men who went to emergency rooms with severe chest pain. Researchers asked detailed questions about their pain. The questions included where exactly the pain was located, whether it spread beyond the chest and what it felt like. About 18% of the women and 22% of the men were actually having a heart attack. Men's and women's answers to the detailed questions about symptoms also were mostly similar. No specific details about the chest pain were definitely linked with a greater chance of having a heart attack. However, women were slightly more likely to be having a heart attack if their pain lasted a long time. The journal JAMA Internal Medicine published the study. HealthDay News wrote about it November 25.
By Howard LeWine, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
During the last decade, doctors have learned that women may not have the same heart attack symptoms as men. That's true. But the differences are not nearly as frequent as we have come to believe.
Heart attack symptoms are actually very similar in both sexes. That's the main finding of a new study published online in the journal JAMA Internal Medicine.
Researchers assigned trained doctors and nurses to ask 34 detailed questions about heart attack symptoms. They wanted to tease out any specific differences between women and men.
For example, chest pain or discomfort is the No. 1 symptom of heart attack. It occurs in more than 80% of men and women who have heart attacks diagnosed by EKG, blood tests or both.
Typically, doctors ask a few standard questions about chest pain. But this study obtained much more detailed information about the chest pain or discomfort. Here are some of the questions researchers asked:
- When did it start?
- How long did it last?
- Where specifically in the chest do you feel the pain?
- How large is the spot where you have pain?
- Does it radiate into any other part of the body -- the neck, throat, back, one arm, both arms etc.?
- What does the pain feel like (pressure, stabbing, burning)?
- Does it hurt more to take a deep breath, cough, sneeze or move?
For more than 90% of these characteristics, no major differences between women and men could be identified.
There were a couple of differences, though.
- If women's pain lasted 2 to 30 minutes and became less intense, the symptoms were less likely to be caused by a heart attack. However, this was not true for men. Sometimes men had heart attacks even though the pain didn't last long.
- Women with heart attacks tended to have longer lasting pain -- 30 minutes or greater -- compared with men.
The conclusion: When it comes to symptoms of heart attack, it's best to use similar clinical decision making for women and men.
What Changes Can I Make Now?
While chest pain is the most common symptom of an actual heart attack, women often have other types of symptoms in the weeks before a heart attack.
Surveys of women who have had a heart attack found that up to 95% of them said they noticed something wasn't right in the month or so before their heart attacks. Two of these symptoms, fatigue and disturbed sleep, were often severe. Some women, for example, said they were so tired they couldn't make a bed without resting.
In comparison, men more often had no such symptoms in the prior month. If they did have symptoms, it was more often occasional chest pain, especially with exertion. Women who did have chest symptoms in the weeks before a heart attack often did not use the term "chest pain." Instead, they described it as discomfort, aching, tightness or pressure.
Heart attack prevention is similar for both sexes:
- Don't smoke. Quitting reduces your heart attack risk within weeks.
- Stick to a heart-healthy diet, such as a Mediterranean-style diet.
- Stay physically active and exercise regularly.
- Keep your blood pressure under control.
- Work to keep your LDL cholesterol and triglyceride levels down and HDL cholesterol up with diet and exercise. Some people may need medicines as well.
What Can I Expect Looking to the Future?
Symptoms of a heart attack may be very similar in both sexes. But there's a large difference in the ages when a heart attack is likely to occur. The average age of first heart attack for a woman is about 10 years older than for a man.
Estrogen probably has a protective effect until menopause. Taking estrogen for a short time after menopause may help reduce heart disease risk. But taking estrogen in older women has the opposite effect -- a higher risk of clots and heart attacks.
So we still have much to learn about how heart disease acts depending on gender.