Not too young to die

When a woman under 55 has a heart attack, she’s twice as likely to die at the hospital as a man of the same age. And chances are, she waited longer before seeking help. Why?

This simple question has complex answers, says Judith Lichtman ’88MPH, ’96PhD, chair of chronic disease epidemiology at the School of Public Health. Lichtman and her coauthors conducted interviews with 30 younger women who had suffered heart attacks, publishing the results in the journal Circulation. Most had family histories of heart disease and individual risk factors. And yet, when they developed chest pains and other symptoms, many delayed seeking treatment until they couldn’t stand it.

“I wanted to do a very deep dive into what was going on in their brain,” Lichtman says. Several themes emerged. Women under 55 think they’re too young for a heart attack—even if, say, their father had one in his 40s. And they often don’t recognize symptoms that fall outside the “Hollywood heart attack,” where someone—usually a man—clutches his chest and falls to the ground. For similar reasons, health-care providers sometimes overlook heart attack symptoms in women.

Even when they suspected a heart attack, many reported, they were reluctant to raise the alarm. One patient, a nurse, described her “sense of relief” on learning she was not mistaken and had, indeed, had a heart attack. While some heart attack symptoms—nausea, back pain, shortness of breath—can be confusing, 93 percent of patients also had chest pain or pressure. Important takeaways, according to Lichtman: “Don’t discount it because you have other symptoms, and don’t discount it because you’re too young.”