Tests used to confirm heart disease will probably pick up the same symptoms in women and men, a new study finds.
The two most prominent symptoms — chest pain (angina) and shortness of breath — are common to both sexes, concludes a study of more than 10,000 people in the United States and Canada.
“In most cases, symptoms of possible blockages in the heart’s arteries are the same [for women] as those seen in men,” study lead author Kshipra Hemal, of the Duke Clinical Research Institute in Durham, N.C., said in a news release from the American College of Cardiology (ACC).
However, the study also found that because standard evaluations don’t include certain heart disease risk factors more common to women than men, it may still be tougher for women to receive an accurate diagnosis.
The study will be presented April 3 at the ACC’s annual meeting in Chicago, and will also be published in the Journal of the American College of Cardiology: Cardiovascular Imaging.
For the research, Hemal’s team compared the test results of people with suspected heart disease. She noted that the research included “one of the largest cohorts of women ever evaluated in a heart disease study.”
The researchers found that chest pain was the main symptom for about 73 percent of women and 72 percent of men, followed by shortness of breath, which occurred in 15 percent of both women and men.
Women were more likely than men to have back, neck and jaw pain, or palpitations as their main symptom. But, the percentage of both sexes with these symptoms was extremely low: back pain, 1 percent of women, 0.6 percent of men; neck or jaw pain, 1.4 percent of women, 0.7 percent of men; palpitations, 2.7 percent of women, 2 percent of men.
Compared to men, women in the study: tended to be slightly older (62 versus 59); were more likely to be non-white; were less likely to smoke or be overweight; and were more likely to have high blood pressure, high cholesterol, a history of stroke, an inactive lifestyle, history of depression and a family history of early onset heart disease.
Women also scored lower than men when it came to assessing their risk for heart disease. According to Hemal’s team, that could be due to the fact that heart disease risk factors that are more common in women — depression, inactivity, and family history of early onset heart disease — are not included in most risk assessments.
“For health care providers, this study shows the importance of taking into account the differences between women and men throughout the entire diagnostic process for suspected heart disease,” Hemal said. “Providers also need to know that, in the vast majority of cases, women and men with suspected heart disease have the same symptoms.”
One expert stressed that while symptoms of heart disease may be similar for men and women, that’s not always the case for the signs of actual heart attack.
The new findings “run counter” to recent data “on differences between symptom presentation between men and women when it comes to heart attacks,” said Dr. Howard Levite, director of cardiology at Staten Island University in New York City.
For example, the American Heart Association notes that while men typically feel crushing chest pain when a heart attack hits, symptoms can be more subtle for women.
Women may feel chest pain — it is still the most common symptom for both sexes — but this pain can also be intermittent, the AHA said. Other symptoms tend to be more common in women than men, such as pain in one or both arms, the back, neck, jaw or stomach; shortness of breath with or without accompanying chest pain; cold sweats, nausea or lightheadedness, the AHA said.
In any case, if a person experiences any or all of these symptoms, they or a loved one should called 911 and receive hospital care as soon as possible, the AHA said.
The key to preventing heart attack is spotting and treating heart disease early. But Levite believes that current testing protocols may leave women at a disadvantage.
“Women are fighting an uphill battle when it comes to convincing doctors that they are having heart-related symptoms, because the standard scoring tests assign them to a lower risk category,” he said. “Factors more commonly found in women, such as anxiety and depression, are not in the current risk scores.”
Dr. David Friedman is chief of heart failure services at Northwell Health’s Franklin Hospital in Valley Stream, N.Y. He agreed that a thorough patient examination is key to good cardiac care.
“A high-quality clinical history of present illness — taking into account a good review of all patient complaints including symptom type, onset, duration, intensity, worsening and improving associated problems — can help us get a ‘back-to-basics’ approach, which can help further define patients’ potential cardiac risk profile”.