Heart Attacks in Women Are More Likely to Be Deadly

Here's a grim statistic: Among people hospitalized for a heart attack, 12 percent of women—but just 6 percent of men—die in the hospital, according to new research to be presented at the American College of Cardiology’s 64th Annual Scientific Session. That means women who suffer heart attacks are twice as likely to die as men.

Why? A major factor is the fact that female heart attack patients are less likely to receive one particular potentially lifesaving treatment when they arrive at the hospital. This treatment, which involves opening clogged arteries (the blood vessels that connect the heart to other parts of the body), is called percutaneous coronary intervention, or coronary angioplasty, but it’s more commonly known as stenting, says John Higgins, MD, an associate professor of medicine at the University of Texas Medical School at Houston. He explains, "It is a non-surgical procedure used to treat the acute blockage of the coronary arteries of the heart found in heart attack patients."

But too often, women don’t get this treatment: Stenting was performed on more than 80% of men but only 76% of women, the study found.

Why do women receive this treatment less frequently? It starts with the fact that "Warning signs of a heart attack may be different in women than men," Higgins explains. "So there is a delay in the woman or others realizing she is having a heart attack, as well as the first medical contact." In addition, "The health care provider may not recognize the early onset of a heart attack due to the presence of atypical or unusual symptoms, so there is often a [further] delay in diagnosis of a heart attack, and in recognizing that a women needs stenting."

Unfortunately, there is a narrow window of time—within a few hours of a heart attack—for optimal use of the stent, and the delays in care-seeking and diagnosis suggest that by the time it’s understood that a women is having a heart attack, some medical professionals may decide not to stent, since the procedure may not be as successful. "Also, there is a higher rate of complications when performing coronary stenting in women, [and] higher in-hospital deaths in women having heart attacks that are treated with stents than men. And women have smaller blood vessels, which are sometimes less amenable to stents," Higgins adds.

Are You at Risk for a Heart Attack?

Most people assume that men are at higher risk of heart attack. They are partially correct: "A man is at greater risk of heart disease than a pre-menopausal woman,” Higgins says. However, “Once past menopause, a woman's risk is similar to a man’s."

There are several other factors that increase your risk of a heart attack; family history and age are among the “non-modifiable” ones—the risk factors you can’t do anything about. So "If a first-degree blood relative has had coronary heart disease or stroke before the age of 55 years (for a male relative) or 65 years (for a female relative), your risk increases," he adds.

Fortunately, that’s not the whole story: Other heart attack risk factors—such as tobacco use, being overweight or obese, and having a sedentary (physically inactive) lifestyle—are modifiable, meaning you can do something about them. Other risk factors, like having hypertension (high blood pressure), type 2 diabetes, and elevated cholesterol are also considered modifiable, says Stacey E. Rosen, MD, Vice President for Women's Health at the Katz Institute for Women's Health in the North Shore-LIJ Health System in New Hyde Park, NY.

More recently, other risk factors for women have come to light, Rosen notes. These include non-modifiable risk factors such as rheumatologic conditions like lupus or rheumatoid arthritis, as well as modifiable pregnancy-related conditions such as gestational diabetes, hypertension (high blood pressure), and preeclampsia, a serious disorder of pregnancy characterized by high blood pressure.

What can you do? Know your risk factors and work with your doctor to minimize them. "Some 80 percent of heart disease is modifiable and often relies on lifestyle improvement in the way of nutrition, adequate sleep, and stress management," Rosen says.

Symptoms to Be Aware Of

The phrase “heart attack” often evokes images of people suddenly clutching their chests and falling to the ground. Men are more likely to experience chest pain (which may spread to the neck or jaw) during a heart attack, says Higgins, though it happens to women, too.

But women are also more likely to experience symptoms they may not recognize as warning signs of a heart attack: "Women may have nausea and vomiting. Other symptoms can be shortness of breath, lightheadedness, and sweating. Breaking out in a nervous cold sweat is common among women who are having a heart attack," Higgins adds.

Rosen agrees, adding that generalized fatigue, back pain, and stomach upset can also indicate a heart attack in women. In fact, women may have discomfort in the lower chest and mistake it for a stomach problem, says Nieca Goldberg, MD, director of the Joan H. Tisch Center for Women’s Health at NYU Langone Medical Center in New York City. "It’s also more common for women to have upper back pressure."

Unfortunately, Rosen says, "The majority of women in the U.S. do not know that heart disease is the number one cause of death for women," or that heart attack symptoms in women may look very different from those in men, for that matter. And women who don’t realize they are at risk for heart disease and develop symptoms may delay getting medical help, she adds.

What Should You Do if You Have Symptoms?

Make sure you have a doctor you can trust, Rosen says. If you have any change in health status, report it to your doctor right away. "Women often take care of themselves last while caring for the needs of loved ones," Rosen says. "Delays in seeking care can certainly play a part in less favorable outcomes for women with heart disease."

If you feel like your doctor isn’t taking you seriously, call 911 or go to the hospital. "And chew a full dose aspirin,” Goldberg advises. “Don’t waste time looking up your symptoms on the Internet."

Can You Prevent a Heart Attack?

It’s crucial to seek medical care promptly if you have heart attack symptoms, but there are also many things you can do to prevent having a heart attack in the first place:

  1. If you smoke, quit. "Smoking more than doubles your chances of developing heart disease," Higgins says.
  2. Keep your blood pressure, cholesterol, and diabetes, if you have it, under control. Manage your blood pressure with medicine, if needed, reduce your salt (sodium) intake, and reduce dietary cholesterol.
  3. Eat healthfully. Eat a diet rich in fresh fruits and vegetables, skinless grilled chicken, fish, olive oil, legumes, nuts, and whole grains. Limit trans and saturated fats, red meat, and sugar.
  4. Limit the amount of alcohol you drink. "One drink a day is associated with reducing the rate of heart attacks in women, but two or more drinks a day can damage the heart and cause other medical problems," Higgins says.
  5. Exercise regularly. Get at least 30 minutes of exercise (jogging, swimming, cycling, cardio, yoga, or gym workouts), or walk 10,000 steps a day on most days of the week.

John Higgins, MD, reviewed this article.


John Higgins, MD. Email interview April 18, 2015.

Nieca Goldberg, MD. Email interview May 4, 2015.

Stacey Rosen, MD. Email interview April 29, 2015.

American College of Cardiology. "Women Don’t Get to Hospital Fast Enough During Heart Attack." Science Daily. March 5, 2015.

"Heart Attack First Aid." MedLine Plus. Page last updated December 12, 2013.

"Preeclampsia and Hypertension in Pregnancy: Resource Overview." The American Congress of Obstetricians and Gynecologists. Page accessed June 8, 2015.