Chest pain is still the most common sign of a heart attack for most women, although studies have shown that women are more likely than men to have symptoms other than chest pain or discomfort when experiencing a heart attack or other form of acute coronary syndrome (ACS), according to an article "Symptom Presentation of Women With Acute Coronary Syndromes — Myth vs. Reality" published online Dec. 10 in the Archives of Internal Medicine. The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

Researchers examined 35 years of research that yielded 69 studies 69 studies and found that, depending on the size of the study (which ranged from large trials to single centers and interviews), between 30 percent and 37 percent of women did not have chest discomfort during a heart attack. In contrast, 17 percent to 27 percent of men did not experience chest discomfort. Overall, the majority of women — and men — in the reviewed studies had chest discomfort with heart attack (two-thirds to three-quarters, depending on study size).

Study authors also found that older people are more likely to have heart attack without chest discomfort. However, because women are on average nearly a decade older than men at the time of their initial heart attack, the researchers call for more studies to determine the degree to which gender independently influences heart attack symptoms.

They conclude that current research does not indicate a need to differentiate heart attack symptoms in women from those in men, and public health messages should continue to emphasize chest pain or discomfort, shortness of breath, and other common signs of heart attack. Coronary heart disease is the leading cause of death among U.S. women, and affects one in 10 women over the age of 18.

The authors also report that women are more likely than men to experience other forms of cardiac chest pain syndromes, such as unstable angina, and they appear to report a wider range of symptoms associated with ACS. For example, women are more likely to report pain in the middle or upper back, neck, or jaw; shortness of breath; nausea or vomiting; indigestion; loss of appetite; weakness or fatigue; cough; dizziness; and palpitations.

Absence of chest discomfort is a strong predictor for missed diagnosis and treatment delays. Noting that many studies exclude patients who do not report chest pain, the researchers call for additional research from well-designed studies to further investigate gender differences in heart attack symptoms. This includes expanding symptom definitions and greater standardization in data collection and reporting of women's symptoms.

Study co-author George Sopko, M.D., Medical Officer with NHLBI's Division of Cardiovascular Diseases, is available for comment. To schedule interviews, contact the NHLBI Communications Office at 301-496-4236 or at nhlbi_news@nhlbi.nih.gov.

Resources:

• Act In Time To Heart Attack Signs is an NHLBI education campaign that that urges physicians to educate their patients about heart attack risk, warning signs, and survival. For information on heart attack warning signs for both the public and health care professionals, http://www.nhlbi.nih.gov/actintime/haws/haws.htm.
• The Heart Truth, NHLBI's national awareness campaign for women about heart disease, aims to spread the word that heart disease is largely preventable. For midlife women, the most common risk factors for heart disease in order of greatest prevalence include overweight/obesity, high blood cholesterol, diabetes, and high blood pressure. For more on The Heart Truth, http://www.hearttruth.gov.
• For current recommendations for heart health, see Your Guide to a Healthy Heart, http://www.nhlbi.nih.gov/health/public/heart/other/your_guide/healthyheart.htm.

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