Heart attacks more likely to kill women

The Associated Press

Under age 50, women's heart attacks are twice as likely as men's to be fatal, but the gap narrows and eventually disappears later in life.

The discovery by Yale University researchers suggests that biological factors -- not differences in medical care -- largely explain why heart attacks are more deadly for women.

This study, like many others, found that women's heart attacks in general are more likely to be fatal. Seventeen percent of female heart attack victims die while still in the hospital, compared with 12 percent of males.

However, when the researchers broke the numbers down by age, they came to the surprising conclusion that the difference results entirely from a much higher death rate among the younger victims.

Under age 50, when heart attacks are especially rare among women, just 3 percent of male victims die, compared with 6 percent of females. By age 75, the death rate for both sexes is about equal, around 19 percent.

Over the years, experts have speculated about why heart attacks are more deadly for women, and some have suggested that differences in medical treatment play a role. While this may be part of the story, the new work suggests that biology is probably a more important factor.

The study, directed by Dr. Viola Vaccarino, was based on a review of the records of 384,878 heart attack victims between 1994 and 1998. It was published in today's issue of the New England Journal of Medicine.

"Probably biological mechanisms play a major role, but we need to look at the big picture and take into account all aspects of the women and their care," Vaccarino said. "Heart disease is the No. 1 killer of women, even among younger women, less than 65."

In earlier work, the Yale team and other researchers found that women wait hours longer after a heart attack before going to the hospital, then are treated less aggressively than men. That delay, which allows further damage to the oxygen-starved heart, results partly because women tend to experience less painful heart attack symptoms. Sometimes they feel only pressure or a burning feeling, not crushing pain.

The researchers also noted that younger female victims are more likely than men to have other health problems, such as diabetes, high blood pressure and heart failure.

Still, the treatment differences and women's poorer overall health only explained one-third of the mortality difference. Those factors being equal, women had a 7 percent higher risk of dying for each five years below age 75. By age 80, the men had a slightly higher risk.

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