Determining the Clinical Presentation of Coronary Ischemia in Women

Viola Vaccarino, M.D., Ph.D.,Associate Professor of Epidemiology and Public Health

Cardiovascular disease is the leading cause of death in both women and men. However, women who suffer a heart attack tend to have less typical signs and symptoms, and are less likely to receive recommended treatments compared to men. Dr. Vaccarino investigated the relationship between signs and symptoms, process of care, and outcome of acute coronary ischemia in women.  The clarification of gender differences in regard to these variables helped set a course for physicians to recognize and treat heart disease in women more promptly with the goal of improved outcomes.

Highlighted Study Findings

In this study, Dr. Vaccarino investigated the relationship between presentation characteristics, process of care, and outcome of acute coronary ischemia in women, using a large population-based cohort of female and male heart attack patients from the Worcester Heart Attack Study. The results showed that only 54% of women hospitalized with a heart attack presented with a chief complaint of chest pain, compared with 69% of men. Although women tended to present less often with a chief complaint of chest pain in all age groups, this gender difference was most marked in older patients. The second most common chief complaint was respiratory (breathing) problems, and younger women were twice as likely to present with respiratory symptoms as their chief complaint than were men of the same age. Despite their relative lack of traditional diagnostic indicators of heart attack, women have more severe clinical abnormalities and higher mortality than do men. Because of less typical presentations, women may delay longer in reaching the hospital, and health care providers may delay appropriate treatments - leading to higher mortality in women. Less typical presentations may also lead to delayed identification of coronary disease in women, with women being diagnosed and treated at more advanced stages of the disease compared with men. Overall, a large number of both women and men who were ultimately diagnosed as having a heart attack did not present with chest pain as their chief complaint. The clarification of gender differences in clinical presentation of acute coronary ischemia will help physicians recognize and treat heart disease in women more promptly, resulting in improved outcomes.