Mortality from heart attacks is higher in women than men – 11/03/2023 – Balance and Health

Coordinator Elen Maria Rodrigues, 45, remembers that fateful November 1st a year ago, and reflects: “today, I would do it differently and go to the hospital at the slightest sign of feeling unwell”.

She refers to the heart attack she suffered, at the age of 44, and that, as she did not have the typical manifestation of symptoms, it took her 20 days to seek medical attention, when the left side of her heart had already suffered a serious injury and one of the main arteries of the heart was already 90% obstructed.

“The discomfort started with a pain between the chest and stomach, but it went away in less than a minute, every day, at more or less the same time, around noon. The day I went to the hospital , I also felt anxiety, intense heat and tingling in my arms, but at no point did I think it was a heart attack”, he said.

She was treated at Hospital Alemão Oswaldo Cruz, in the central region of São Paulo where, after some tests, the doctor informed her of the heart attack and said that if she had just a little longer, she could have died.

After seven days of hospitalization, a catheterization (insertion of a catheter through a tube whose function is to unblock the heart vessels) and a stent (“spring” that keeps the artery open, preventing its obstruction), Rodrigues faces the life of differently, paying more attention to your condition. “My children are already adults, but I was always responsible for taking care of them, my husband, the house, and I ended up neglecting my health, my well-being.”

According to a global survey with data from more than 250 million patients in 120 institutions, to which Sheet had access, her case is not isolated: the risk of death 30 days to a year after a heart attack is higher in women than in men.

The reasons behind this difference may be biological, such as the manifestation of heart attack symptoms that are not typical in women, who tend to present milder symptoms, but it may also be related to the type of care they receive and even social and gender factors. , they say.

“In general, women have more discreet symptoms of a heart attack, as do older patients, where around 10% do not have chest pain. This can lead to errors in diagnosis, as well as the patient herself ending up delaying seeking help ” says Hélio Castello, cardiologist at Hospital Alemão Oswaldo Cruz and one of the authors of the study, which was presented at the Brazilian Congress of Hemodynamics and the Latin American Congress of Interventional Cardiology, in Rio de Janeiro, in August.

The research compared data from electronic medical records of patients aged 18 and over available on the TriNetX platform, a real-world data sharing network for observational scientific studies. The participants included in the study had an acute myocardial infarction with ST elevation (when there is a sudden blockage of blood flow to a part of the heart muscle). The data collected were from 19 countries, with Oswaldo Cruz being one of 29 Brazilian centers.

During the analysis period, 509,229 patients had a heart attack event, 187,208 women and 322,021 men. Among men, 73.8% underwent catheterization, a statistically higher number compared to women (70.9%). However, the risk of death from a heart attack was 24% higher in women both in the first month and up to one year after the event compared to men. They were also older and had a higher prevalence of comorbidities, such as hypertension, diabetes and overweight, which may explain the high risk of death from heart disease.

“The incidence of cardiovascular disease is higher in men than in women, but what we saw in the research is that they arrive at the hospital at an older age, which may have influenced the death outcome”, says Castello. “When we see the difference between women and men who underwent catheterization, it is likely that there is also a difference in relation to the accurate diagnosis of heart attack in women, which leads to a delay in guidance for treatment.”

Cardiovascular diseases are the main cause of death in men and women from illness in Brazil, according to data from DataSUS. In the case of women, heart disease has a higher mortality rate than all types of cancer.

The epidemiologist and professor at the Faculty of Medicine at USP, Paulo Lotufo, who did not participate in the study, points out that previous research carried out in Brazil also found a slightly higher risk of death from heart attack in women, although these data should be viewed with caution due to to regional and economic class differences in the country, which impact access to healthcare.

However, it reinforces doctors’ lack of appreciation for the symptoms reported by female patients, a type of gender discrimination reflected in the type of teaching at medical schools. “We learn that the typical heart attack patient is a white man, aged 60 or over. When a woman arrives at the hospital reporting symptoms, many doctors and health professionals interpret [erroneamente] as if it were something minor, symptoms of menopause, and this ends up delaying care”, he states.

This data was also highlighted in the research, which concluded that care protocols must be more rigorous for the diagnosis of heart attack, especially when caring for female patients.

A study conducted in the USA and Canada showed that women generally receive less cardiac massage when they suffer an arrest than men. In the research, the authors point out as a possible cause the view of health professionals that women suffer fewer heart attacks. Thinking about these gender differences, the Brazilian Society of Cardiology published, last year, a guideline to reduce female mortality due to cardiovascular diseases by 30%.

“We need to raise awareness about the care and prevention of heart attacks. And one of the things that we, doctors, and scientific societies are concerned about is how you, as a professional, will worry about this, what types of signs and complaints from the patient will lead to emergency care and the correct diagnosis of heart attack”, adds the cardiologist.

The hallmark of your experience is that, at the slightest sign of discomfort or pain in your chest, you immediately call your doctors and seek help, says Rodrigues. “I will no longer wait to seek help, I will no longer belittle my symptoms”, he concludes.

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