Diagnosing heart disease in younger women. Or not.

School of Public Health

Lead author Judith Lichtman. View full image

Heart disease is one of the leading causes of death among US women younger than 55. In fact, young women are more likely to die of heart attacks than are men of the same age. But the reasons for the gender discrepancy are not clear.

In a study led by Yale, researchers interviewed men and women aged 18 to 55 who had been hospitalized for acute myocardial infarction. The patients were asked what symptoms they’d had, what they had thought was causing their symptoms, and if they’d seen a health-care provider for the symptoms in the week before they sought hospital care.

In all, the interviewers spoke with 2,009 women and 976 men. In each group, nearly 90 percent of the patients had felt chest pain or discomfort. But the women were somewhat more likely to have had several additional symptoms, such as gastrointestinal problems, palpitations, or pain in the arms, jaw, neck, or between the shoulder blades. About 21 percent of the women had believed their problem was stress or anxiety, versus 12 percent of the men. 

And, while women were more likely to seek care before hospitalization, 53 percent of those who did so said their providers didn’t think they had a heart issue, versus 37 percent of the men. (The study was published in Circulation.)

“We are hypothesizing that ischemic heart disease in women may not be recognized promptly because of the constellation of symptoms that women are more likely to present,” says study coauthor Gail D’Onofrio, chair of the Yale medical school’s Department of Emergency Medicine. Lead author Judith Lichtman ’88MPH, ’96PhD, adds: “Our message to patients is to seek prompt care when experiencing any chest-related symptoms, even if combined with other symptoms.” (Lichtman is chair of the chronic disease epidemiology department at the School of Public Health.) The message to clinicians, she says, is: listen carefully to younger patients—especially those with a history of cardiac risk factors—and recommend a cardiac workup if symptoms point to heart disease.