Heart attacks can happen to women, too – but are less likely to be recognised Cand diagnosed. Helen Foster reports on the hidden health gender gap...

Close your eyes and imagine someone having a heart attack. What comes to mind? If it’s a paunchy, middle-aged man clutching his chest, you might want to rethink – new research suggests that thinking of heart attacks as a male problem could seriously damage your health. Right now, more women die of heart attacks than of breast cancer – despite most of us believing that cancer is our biggest risk.

In the UK four women every hour are rushed to hospital suffering a heart attack – but worryingly, new research has revealed that when these women arrive at A and E, they don’t always get the same treatment as men. In fact, a recent study from Leeds University found that women having a heart attack were 50 per cent more likely to be given an incorrect diagnosis. Heart attacks happen when one or more of the arteries in the body become narrowed from fatty deposits building up on the artery wall. If one of these deposits breaks off, the body tries to repair the damage by forming a blood clot – but occasionally, that clot can block blood flow and cause a cardiac arrest.

While the anatomy of a heart attack is the same for both sexes, the diagnosis and treatment is not. The British Heart Foundation (BHF) calculates that this ‘heart attack gender gap’ could have led to the deaths of 8,200 women in England and Wales in the last decade – a figure that has prompted the BHF to launch a campaign to make women, and the doctors helping them, more aware of symptoms, diagnosis and treatment in females.

‘There are two main reasons why women aren’t receiving the same treatment as men, starting with biology,’ says Chris Gale, Professor of Cardiovascular Medicine at The University of Leeds. ‘Women have smaller hearts and coronary arteries than men. They tend to have heart attacks about nine to 10 years later in life, and usually have other illnesses as well. This combination can make heart attacks in women harder to treat. However, there’s also an element of bias from both women and the medical profession that affects how things are handled.’ And it’s this element that the BHF hopes we can address.

Let’s start with the bias about who has heart attacks: it’s been shown that both patients and doctors tend to think of it as a male problem. This means that a woman experiencing heart attack symptoms is more likely to ignore them; one study showed that women wait at least 25 minutes – and sometimes almost four hours – longer before calling an ambulance, than men who are having the same symptoms. ‘If you’re having a heart attack, every minute counts,’ says Professor Gale. ‘Treatments like thrombolytic drugs that dissolve blood clots, or opening the arteries, need to be done early.

We know women worry about wasting people’s time, but we would much rather you came to hospital only for us to send you home, than see you too late to give you the best help.’ Of course, to know that we need to call an ambulance, we need to recognise the symptoms of a heart attack – and here, further gender confusion has developed. A few years ago, some US studies suggested that women may have different presenting symptoms to men. However, ‘a huge new study in the UK has disproved that and found that both sexes experience exactly the same symptoms, including that crushing chest pain we commonly associate with the problem,’ says Dr Ken Lee, BHF clinical research fellow and cardiology specialist at the University of Edinburgh. Our check box opposite gives the main symptoms to be aware of. ‘If you experience these, call 999 immediately,’ says Julie Ward, senior cardiac nurse at the BHF. ‘Paramedics have clear routes they follow if a heart attack is suspected and will take you straight to the best hospital. Never try to drive yourself. It’s potentially dangerous for you and others, and can also delay treatment.’

Thankfully, if you are having a heart attack, it’s now more likely to be successfully recognised thanks to some recent work by Dr Lee and his Edinburgh colleagues. A diagnosis is usually reached by measuring the levels of a protein called troponin, released into the bloodstream when the heart is damaged. But the Edinburgh team discovered that women release less troponin than men do, and that using a lower troponin threshold for women picked up 42 per cent more female heart attack victims than previously. It’s hoped that this lower threshold will be adopted across the UK, improving diagnosis rates in the future.

Obviously, however, a better solution is to protect your heart and try to reduce your risk of having a heart attack in the first place – and here, there is one more gender myth to dispel; that oestrogen magically protects women against heart disease. ‘It’s not completely untrue – it does convey some protection, until menopause,’ says Professor Gale. ‘But it’s not a magic bullet and it won’t counteract major risk factors like smoking.’ In fact, smoking increases women’s risk of suffering a heart attack up to twice as much as it does men’s, and high blood pressure by up to 80%. Given this, it’s even more important that we work to protect our hearts. The cardinal rules? Don’t smoke, don’t drink to excess, aim to stay a healthy weight, exercise three to five times a week for at least 30 minutes and get your blood pressure and cholesterol checked every few years.

‘Being aware of how heart attacks affect women and how regularly they happen helps ensure you’re more likely to respond in a way that gives you the best chance to be treated quickly and appropriately,’ says Julie Ward. ‘And if you do end up in hospital, don’t be afraid to ask the medical team questions about what’s happening – if you’re being given the most appropriate test, or if you’re getting the best treatment.’ As part of their campaign, The British Heart Foundation point out that heart attacks have never been more treatable than they are today. But understanding our risks and how to protect against them can only strengthen the potential for successful results. Here’s to a long, heart-healthy life.

Heart attack symptoms - know when to seek help

Heart attack symptoms can vary in severity between individuals, but according to the British Heart Foundation the most common are:

● Chest pain or discomfort that suddenly occurs and doesn’t go away. It may feel like pressure, squeezing or heaviness in your chest

● Pain that may spread to your left or right arm or may spread to your neck, jaw, back or stomach

● Feeling sick, sweaty, light-headed or short of breath

Less common include:

● A sudden feeling of anxiety that can feel similar to a panic attack

● Excessive coughing or wheezing