Why Is Heart Disease More Deadly In Young Women Than Men?

Many people still think of older men as the primary victims of heart disease. Yet cardiovascular disease remains the leading cause of death for both men and women in the United States, despite great strides in diagnosis and treatment over the last several decades.

Research has shown that women may have fewer and somewhat different symptoms of heart disease than men. For instance, rather than the classic tightness in the chest and pain radiating down the arm typically reported by men experiencing a heart attack, women may describe discomfort similar to indigestion, unusual fatigue or shortness of breath out of proportion to the level of exertion.

Women may also be treated differently by physicians, especially in the hospital, where they are less likely than male patients to receive aggressive diagnosis and treatment for heart attacks.

Further differences between the sexes involving heart disease and age are coming to light. Most studies, when adjusted for other variables, indicate that older patients with diseases tend to fare worse than younger ones. This may not be the case for younger women with heart disease, specifically those with coronary artery disease suffering a heart attack.

Despite the perception that younger women are somewhat protected from heart disease, statistics from the American Heart Association and Department of Health and Human Services indicate otherwise. Approximately 10,000 U.S. women ages 28 to 44, and 88,000 ages 45 to 64, suffer heart attacks each year. More than 16,000 women younger than 55 die prematurely from coronary artery disease yearly in the United States, making it one of the leading causes of death in this group. Even more disturbing, women younger than 55 who make it to the emergency room with a heart attack are nearly twice as likely as men the same age to die at the hospital. The risk of dying the first year following hospital discharge is 50 percent higher for women who survive heart attacks than for their male counterparts. The outcome is even worse for young minority women.

Increasing awareness that heart disease is particularly deadly among young women has sparked much interest in the medical community. The National Institutes of Health recently launched the largest, most comprehensive study of young women with heart attacks - VIRGO (Variation In Recovery - Role of Gender on Outcomes in young acute myocardial infarction patients). Pepin Heart Hospital and the Kiran Patel Research Institute is the only clinical research site in the greater Tampa Bay area for VIRGO, which encompasses a network of more than 100 hospitals nationwide. Over the next few years, we will evaluate all younger patients admitted with heart attacks (women and men age 55 and younger) to determine the causes of historically worse outcomes in women and to help define diagnostic and treatment strategies to remedy the gender disparity.

This landmark national study will address many questions, including genetic, demographic, psychosocial and behavioral factors that may contribute to premature heart disease in women and how differences in clinical presentation and treatment processes may affect patient risk and outcome. The answers should help us more definitely explain what accounts for the deadly outcome of heart disease in young women - an understudied group.

Dr. Lambert is professor of cardiology at USF Health and medical director of the Pepin Heart Hospital and Kiran Patel Research Institute.