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Even though heart disease is the leading cause of death for women in America — responsible for one in four deaths — heart disease and heart attacks remain dangerously underdiagnosed and undertreated among women, according to a new statement by the American Heart Association.

The statement, published Monday in the journal Circulation, is the first the association has ever issued on women’s heart attacks. “People are predisposed to think of heart disease as a man’s disease,” said Dr. Marie Gerhard-Herman, a cardiologist at Brigham and Women’s Hospital. But women suffer about half of the heart attacks that happen in the United States each year. Despite that, research on women’s heart health has been lackluster, which has made it difficult to do an analysis of this kind before now.


“We have more data on women with heart attacks than we ever had before,” said Dr. Laxmi Mehta, the study author and a women’s cardiovascular health researcher at Ohio State University. But “we need more women in cardiac research studies. … Our current knowledge is based mostly on research on men.”

The reasons for the disparity are wide-ranging. One contributor is that heart disease, which increases a person’s risk for heart attack, is harder to detect in women. “If you look at the pipes in your house and they’re diffusely lined with crud, that’s what women’s heart disease look like,” Gerhard-Herman said. Men’s heart disease, on the other hand, is more often a buildup of plaque in one spot. Women’s coronary arteries are often smaller than mens, too, which makes it difficult to use the typical angiogram test to check for cholesterol buildup.

Symptoms of a heart attack itself also differ. Chest pain and discomfort crop up in both women and men, but women also experience different symptoms, such as nausea, back and jaw pain, and intermittent shortness of breath.


“If a woman [with heart disease] is walking to her mailbox, she might have to stop and rest in between,” said Jean McSweeney, a University of Arkansas nurse who has done extensive research on women’s heart health. McSweeney said shortness of breath that interferes with everyday life can appear months before a woman has a heart attack, and those symptoms will often come and go.

“But when these symptoms appear when they’re actually having a heart attack, they think the symptoms are going to go away again, but they don’t,” McSweeney said.

Consequently, women might wait longer before going to the hospital, McSweeney suggested. And those differences can complicate the diagnostic process when those women do seek medical help.

“The symptoms, if they’re not completely classic, don’t trigger alarm bells in patients themselves or the people initially taking care of them,” Gerhard-Herman said.

There’s also a gender gap when it comes to heart attack outcomes. Women are prone to more complications than men after a heart attack, in part because their blood vessels are typically smaller. Women are also prescribed the recommended interventions — including cardiac rehabilitation and medications — less frequently than are men. The reasons for that aren’t clear.